System and method for positioning a laparoscopic device

ABSTRACT

A laparoscopic instrument holder for positioning a laparoscopic device includes a central portion having a first member operatively associated with a second member, the members selectively movable with respect to one another along a central axis, with the central portion having a proximal end defined by the first member and a distal end defined by the second member. The holder also includes at least three proximal rotational joints coupled to the first member proximate the proximal end, at least two distal rotational joints coupled to the second member proximate the distal end, a first ball and socket joint coupled to a distal rotational joint, and a second ball and socket joint coupled to the first ball and socket joint. In addition, the holder includes a clamp configured and dimensioned for retaining a laparoscopic device, with the clamp coupled to the second ball and socket joint, and a coupling portion proximate a first of the proximal rotational joints.

CROSS-REFERENCE TO RELATED APPLICATIONS

The benefits of Provisional Application No. 60/982,398 filed Oct. 24,2007 and entitled “System and Method for Positioning a LaparoscopicDevice” are claimed under 35 U.S.C. § 119(e), the entire contents ofthis provisional application being expressly incorporated herein byreference thereto.

This application also is a continuation-in-part of application Ser. No.11/464,804 filed Aug. 15, 2006 and entitled “System and Method forPositioning a Laparoscopic Device,” which (1) is a continuation-in-partof application Ser. No. 11/095,586 filed Apr. 1, 2005, now U.S. Pat. No.7,395,563 B2, and entitled “Support System for Use When PerformingMedical Imaging of a Patient” which claims the benefits of ProvisionalApplication No. 60/559,414 filed Apr. 2, 2004, Provisional ApplicationNo. 60/575,792 filed May 28, 2004, and Provisional Application No.60/614,593 filed Oct. 1, 2004 under 35 U.S.C. § 119(e), the priority ofwhich is claimed and the entire contents of each of these applicationsbeing expressly incorporated herein by reference thereto, and which (2)claims the benefits of Provisional Application No. 60/709,098 filed Aug.18, 2005, Provisional Application No. 60/730,853 filed Oct. 28, 2005,Provisional Application No. 60/772,863 filed Feb. 14, 2006, andProvisional Application No. 60/773,638 filed Feb. 16, 2006, eachentitled “System for Positioning a Laparoscopic Device,” as well asProvisional Application No. 60/821,692 filed Aug. 7, 2006 and entitled“System and Method for Positioning a Laparoscopic Device” under 35U.S.C. § 119(e), the priority of which is claimed and the entirecontents of these provisional applications being expressly incorporatedherein by reference thereto.

FIELD OF THE INVENTION

The invention relates to a system for positioning a laparoscopic device.In particular, the invention relates to a holder and curvilineararticulating arm for positioning a laparoscopic device such as anendoscopic camera.

BACKGROUND OF THE INVENTION

During laparoscopy, a minimally invasive surgical procedure in whichtissue for example may be removed from the abdomen or chest through asmall puncture wound, the laparoscopic surgery is performed with the aidof an endoscopic camera. The camera is placed through a port in the skininto a working cavity and may be used for example to visually examinethe interior of the cavity such as the peritoneum or surgical planes orspaces created for purposes of dissection. Typically, the cameraincludes a light source. Correct positioning and aim of the laparoscopiccamera and light throughout a procedure are fundamental to laparoscopy.

Most commonly, the endoscopic camera is held by an assistant who mustcontinually watch the video monitor and hold a steady position until thesurgeon requests a change in the field of view. Alternatively, a varietyof robotic arms have been designed to hold the camera and move forexample on voice command by the surgeon. Such systems include the AESOP®(Automated Endoscopic System for Optimal Positioning) voice controlledrobot system and the Zeus® minimal invasive surgical robot system fromComputer Motion Inc./Intuitive Surgical Inc. Mechanical/electricalservomotor controlled systems that move by foot controls, palm andfingertip controls include the LAPMAN® by MedSys s.a. of Belgium, whilea remote, manual control system da Vinci® is available from IntuitiveSurgical Inc.

In addition, a variety of known mechanical frameworks that have multipleadjustment and locking points can be used to hold an endoscopic cameraincluding a laparoscopic retractor from Thompson Surgical Instruments,the Martin Arm System from Gebrüder Martin GmbH & Co. KG, and theOmni-Tract® surgical retractors from Minnesota Scientific Inc. Thesedevices have the capability of holding other laparoscopic instruments aswell, although different connections at the instrument interface may berequired depending on the instrument and the application.

The first choice for any surgeon is to have a good human assistant, whocan continuously and accurately aim and focus the camera and light onthe moving surgical field. Unfortunately, good assistance, or anyassistance for that matter, is frequently unavailable, and the surgeonmust work solo. Also, occasions frequently arise where an assistant'shands may be occupied by other tasks, such as retraction and suction,and in these circumstances other means for holding the camera also arerequired. The alternatives for holding and positioning the camera citedabove then come into play. However, these alternatives each have one ormore troublesome drawbacks. The high end robotic arms (such as da Vinci)are expensive, have high maintenance requirements, are time consumingand cumbersome to set up and may have high cost disposable components.They also require an experienced assistant or technician to be present.The simpler, voice controlled (AESOP) or palm radio controlled (LAPMAN)robotic arms also require significant maintenance and set up time, movetoo slowly for many surgeons, and are hard to precisely control. Themechanical arms and frameworks that are available typically have toomany movable parts that require adjustment, require two hands forre-positioning, may have a large footprint near the surgical field, andare very slow to re-position because of the several joints that must beloosened and retightened.

Thompson Surgical Instruments also offers a Flexbar Scope Holder(product #42133C). This device has a clamp to the bedside railing and aset of stainless steel rods that may be clamped at a desired length withright angle clamps to position the base attachment of a curvilinearflexible arm. The arm uses a combination of a screw and cam lockingmechanism to achieve an adjustable friction lock of the arm. In thisdevice, the clamp that holds the laparoscopic camera at the free end ofthe flexible arm has limited capabilities; the clamp becomes lockeddimensionally with the arm and is not a universal joint. The design ofthe scope holder generally requires a user to loosen and then retightenthe locking mechanism for the arm whenever it is necessary to repositionthe laparoscope.

Thus, there remains a need for better holding and positioning devicesfor laparoscopic instruments in general and for the laparoscopic camera(laparoscope) in particular. In particular there is a need for a devicethat will hold a laparoscope steady when it is not in hand, may bequickly re-positioned using one hand, allows quick engagement anddisengagement to a laparoscopic instrument, and has a minimal andmovable footprint on the surgical field.

SUMMARY OF THE INVENTION

The invention relates to a system for positioning a laparoscopic device,the system having a holder. The holder includes a central portion havinga first member operatively associated with a second member, the membersselectively movable with respect to one another along a central axis,the central portion having a proximal end defined by the first memberand a distal end defined by the second member. The holder also has atleast three proximal rotational joints coupled to the first memberproximate the proximal end, at least two distal rotational jointscoupled to the second member proximate the distal end, a clampconfigured and dimensioned for retaining a laparoscopic device, and acoupling portion proximate a first of the proximal rotational joints. Afirst of the distal rotational joints is coupled to the distal end ofthe central portion and a second of the distal rotational joints iscoupled to the clamp.

In some embodiments, the members may telescope with respect to oneanother. The second member may be slidably received in the first member.The first member may have a slot and the second member may have aprotrusion, the protrusion movable within the slot. For example, theprotrusion may include a roller key. Also, in some embodiments, thesecond member may include a piston member proximate an end thereof, thepiston member disposed within the first member. The piston member may bespring-loaded with a spring oriented transverse to the central axis.

The first member may include a receiving end for receiving the secondmember and a bushing coupled to the receiving end, with the bushinghaving a plurality of fingers disposed radially with respect to thecentral axis.

Each of the proximal and distal rotational joints may include a thrustbearing which may be a steel ball thrust bearing. In addition, each ofthe proximal rotational joints may include a washer abutting a spacerand rotatable with respect to each other. In some embodiments, thespacer may be formed of a material that ispolytetrafluoroethylene-based. Each of the distal rotational joints mayinclude a washer abutting a spacer and rotatable with respect to eachother. In some embodiments, the spacer may be formed of a materialcomprising acetal homopolymer. Each of the proximal and distalrotational joints may include a spacer, each of the spacers of theproximal rotational joints having a first thickness and each of thespacers of the distal rotational joints having a second thickness, thefirst thickness being smaller than the second thickness.

The at least three proximal rotational joints may be three proximalrotational joints that each permit movement in a separate plane, and atleast two of the planes may be parallel to one another.

The first of the distal rotational joints may permit rotation about anaxis coinciding with the main axis and the second of the distalrotational joints may permit rotation about an axis transverse to themain axis. Also, the second of the distal rotational joints may permitrotation about an axis generally perpendicular to the main axis.

The clamp may include a pair of spring-biased jaw members each having acover formed of a material softer than aluminum, the clamp beingconfigured and dimensioned to retain the laparoscopic device whilecontacting the covers. For example, each cover may be formed ofpolyurethane.

The laparoscopic device may have a cylindrical portion. The first membermay be tubular. Each of the proximal and distal rotational joints mayhave a first portion rotatable with respect to a second portion about afixed axis. The first and second members may be movable with respect toeach other along the central axis but may not be rotatable with respectto each other.

The system may further include a curvilinear articulating arm, theholder being coupled to the curvilinear articulating arm. In addition,the system may further include a tray configured and dimensioned forsupporting a mammal, the curvilinear articulating arm being coupled tothe tray.

The coupling portion may include a clamp for coupling to a support,wherein the support is selected from the group consisting of a rail of atable and a rail of a bed.

Each proximal rotational joint and each distal rotational joint maypermit 360° of rotation about an axis thereof.

The invention also relates to a system for positioning a laparoscopicdevice including a curvilinear articulating arm and a holder having atleast two rotational regions and a clamping portion for receiving thelaparoscopic device, the holder being coupled to the curvilineararticulating arm. The at least two rotational regions are permitted toarticulate. The holder may further include a central portion with aselectively adjustable length along a central axis, wherein the at leasttwo rotational regions are disposed between the central portion and theclamping portion. In some embodiments, the holder further includes acentral portion with a selectively adjustable length along a centralaxis, the central portion having a proximal end and a distal end,wherein the at least two rotational regions includes at least threeproximal rotational joints disposed proximate the proximal end and atleast two distal rotational joints disposed between the distal end andthe clamping portion. The at least two rotational regions may include athrust bearing.

In addition, the invention relates to a method of positioning alaparoscopic device in a skin port of a mammal, the method including:coupling the laparoscopic device to a holder comprising a clampingportion and five rotational joints, the laparoscopic device beingpartially retained in the clamping portion; disposing the laparoscopicdevice partially within the skin port; positioning the laparoscopicdevice by selectively rotating portions of the holder with respect toone another. The method may further include positioning the laparoscopicdevice by selectively adjusting a length of the holder along a centralaxis. The holder may further include first and second membersselectively movable with respect to one another. The length may beselectively adjustable by moving the first and second members withrespect to each other. The length may be selectively adjustable bytelescoping the first member with respect to the second member. Movementof the first and second members may be restricted to linear movementalong the central axis, and the holder may be manually operated.

In some embodiments, the method may further include: coupling the holderto a curvilinear articulating arm; and articulating the curvilineararticulating arm. Also, the method may further include: coupling thecurvilinear articulating arm to a tray configured and dimensioned forsupporting the mammal. Moreover, the method may further include:coupling the curvilinear articulating arm to a support, wherein thesupport may be selected from the group consisting of a rail of a tableand a rail of a bed. The laparoscopic device may be held in a selectedposition while disposed partially within the skin port without lockingmovement of the rotational joints of the holder.

The invention also relates to a method of positioning a laparoscopicdevice in a skin port of a mammal, the method including: securing thelaparoscopic device to a holder comprising at least two rotationaljoints; coupling the holder to a curvilinear articulating arm; disposingthe laparoscopic device partially within the skin port; positioning thelaparoscopic device by selectively articulating the curvilineararticulating arm and selectively rotating portions of the holder withrespect to one another.

The method may further include: positioning the laparoscopic device byselectively adjusting a length of the holder along a central axis,wherein the holder further comprises first and second membersselectively movable with respect to one another, and wherein the lengthis selectively adjustable by moving the first and second members withrespect to each other. Also, the laparoscopic device may be held in aselected position while disposed partially within the skin port withoutlocking movement of the rotational joints of the holder.

The invention further relates to a system for positioning a laparoscopicdevice such as a camera, the system including a curvilinear articulatingarm and a holder that has at least two rotational regions as well as aclamping portion for receiving the laparoscopic device. The holder iscoupled to the curvilinear articulating arm, and wherein the at leasttwo rotational regions are permitted to articulate. The at least tworotational regions may be provided by one or more types of structuresselected from the group consisting of a rotational joint, a rockingjoint, and a living hinge. The at least two rotational regions may bepermitted to freely articulate.

The invention also relates to a method of positioning a laparoscopicdevice in a skin port of a patient, the method including: securing thedevice in a holder permitted to articulate about at least two rotationalregions; coupling the holder to a curvilinear articulating arm;disposing the device partially within the skin port; positioning thedevice by articulating the curvilinear articulating arm with the devicemoving in response to the articulation. The orientation of the device,such as a laparoscopic camera, thus may be set. The holder may bepermitted to freely articulate about at least two rotational regions.

In yet another exemplary embodiment, the invention relates to alaparoscopic instrument holder for positioning a laparoscopic deviceincluding a central portion having a first member operatively associatedwith a second member, the members selectively movable with respect toone another along a central axis, the central portion having a proximalend defined by the first member and a distal end defined by the secondmember. The holder also has at least three proximal rotational jointscoupled to the first member proximate the proximal end, at least twodistal rotational joints coupled to the second member proximate thedistal end, a first ball and socket joint coupled to a distal rotationaljoint, and a second ball and socket joint coupled to the first ball andsocket joint. In addition, the holder has a clamp configured anddimensioned for retaining a laparoscopic device, with the clamp coupledto the second ball and socket joint, and a coupling portion proximate afirst of the proximal rotational joints. In some embodiments, themembers may telescope with respect to one another and the second membermay be slidably received in the first member. Each of the proximal anddistal rotational joints may have a thrust bearing which may be a steelball thrust bearing. Each ball and socket joint may have a ball and awasher. In an exemplary embodiment, the first ball and socket joint mayhave a first ball and the second ball and socket joint may have a secondball, and the first and second balls may be rigidly coupled to eachother such as by a shaft. Each socket may have a hole with a rim forlimiting angulation of the shaft.

Another exemplary method of positioning a laparoscopic device in a skinport of a mammal includes: securing the laparoscopic device to a holdercomprising at least three proximal rotational joints, at least twodistal rotational joints, and at least two ball and socket joints;coupling the holder to a curvilinear articulating arm; disposing thelaparoscopic device partially within the skin port; positioning thelaparoscopic device by selectively articulating the curvilineararticulating arm and selectively orienting portions of the holder withrespect to one another. The laparoscopic device may be retained in aclamp, and the positioning may include angulating the clamp using theball and socket joints. The holder may further have first and secondmembers coupled to one another, and the positioning may includeselectively moving the first and second members with respect to eachother. In some embodiments, the first and second members may telescopewith respect to each other and the holder may be manually operated. Themethod may further include coupling the curvilinear articulating arm toa patient support.

The present invention further relates to a new set of devices and amethod that is particularly suited for holding, positioning andrepositioning a laparoscopic camera throughout a laparoscopic surgicalprocedure. The device includes a holder with joints for permittingrotational movement and positioning of a clamping end for securing alaparoscopic instrument. Fixed positioning and manual re-positioning maybe quickly accomplished by simply overcoming the modest frictionalresistance to movement within the devices without any mechanicaladjustments after the initial set up. The joints of the holder mayremain free to move at all times. When the holder is static itpreferably will not move, and thus, in effect, becomes self lockingbecause of the physical/mechanical relationship of the various systemcomponents including the laparoscopic instrument such as an endoscopiccamera which is secured in the holder and extending through the skin ofthe patient. In addition, the multi-modality holder has alternativefunctionality for holding and positioning other laparoscopicinstruments.

In one exemplary embodiment, the present invention comprises anarticulating arm that may be attached at one end to a surgical table,and that has the capability of movement in three dimensions (i.e., atleast three degrees (x, y and z) of freedom) at a free end. This arm hasa receiving mechanism at the free end that can accept a variety ofinstrument holding devices one of the main ones of which is alaparoscopic instrument holder for coupling to the free end of thearticulating arm and for positioning a laparoscopic device such as anendoscopic camera.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred features of the present invention are disclosed in theaccompanying drawings, wherein:

FIG. 1 is a perspective view of a laparoscopic instrument holder systemaccording to the present invention, showing an exemplary arrangementwith a holder 100 although the other exemplary holders disclosed hereinmay instead be used in such a system in place of holder 100;

FIGS. 2A-2I show a first embodiment of a laparoscopic instrument holderaccording to the present invention, including (2A) a perspective view,(2B) a partial cross-sectional front view of a portion of the holder,(2C) a front view, (2D) a back view, (2E) a first side view, (2F) asecond side view, (2G) a bottom view, (2H) a top view, and (2I) aperspective view of the mating of movable clamping jaws 122 and fingerrest portion 126;

FIGS. 3A-3G show another embodiment of a laparoscopic instrument holderaccording to the present invention, including (3A) a perspective view,(3B) a front view, (3C) a back view, (3D) a first side view, (3E) asecond side view, (3F) a bottom view, and (3G) a top view;

FIGS. 3H-3N show yet another embodiment of a laparoscopic instrumentholder according to the present invention, including (3H) a perspectiveview, (3I) a front view, (3J) a back view, (3K) a first side view, (3L)a second side view, (3M) a bottom view, and (3N) a top view;

FIG. 3-O shows a perspective view of the holder of FIGS. 3H-3N with amodified member and clamping portion mounted thereon;

FIG. 3P-3Q show another embodiment of a laparoscopic instrument holderaccording to the present invention, including (3P) a perspective viewand (3Q) a front view;

FIG. 3R shows a perspective view of a portion of another clamping systemfor use with the present invention;

FIG. 3S shows a partial cross-sectional side view of the clamping systemof FIG. 3Q;

FIGS. 3AA-3EE show another embodiment of a laparoscopic instrumentholder according to the present invention, including (3AA) a perspectiveview with a laparoscopic instrument retained by said holder, (3BB) apartial perspective view, (3CC) a partial cross-sectional perspectiveview, (3DD) another perspective view, and (3EE) another partialcross-sectional perspective view;

FIGS. 3FF-3-UU show another embodiment of a laparoscopic instrumentholder according to the present invention, including (3FF) a perspectiveview with a laparoscopic instrument retained by said holder, (3GG) apartial perspective view including several rotational joints, (3HH) apartial cross-sectional perspective view including the rotational jointsof the previous figure, (3II) another partial perspective view includingthe rotational joints of the previous figure, (3JJ) a partial bottomview of the linear length adjustment portion of the holder, (3KK) apartial top view thereof, and (3LL) a partial cross-sectional side viewthereof, (3MM) a partial cross-sectional side view of a couplingassembly, (3NN) a partial perspective view of several rotational joints,(3-OO) another partial cross-sectional perspective view of severalrotational joints and clamp, (3PP) a side view of a clamp, (3QQ) anotherside view of the clamp, and (3RR to 3UU) partial perspective views ofthe clamp;

FIGS. 3VV-3WW show an embodiment of a rotational joint for use withlaparoscopic instrument holders of the present invention, including(3VV) a partial side view and (3WW) a partial cross-sectional side view;

FIGS. 3XX-3ZZ show another exemplary embodiment of a coupling portionfor use with laparoscopic instrument holders of the present invention,including (3XX) a first side view, (3YY) a second side view, and (3ZZ) apartial cross-sectional perspective view;

FIGS. 3AAA-3HHH show another embodiment of a laparoscopic instrumentholder according to the present invention, including (3AAA) aperspective view with a laparoscopic instrument retained by said holder,(3BBB) a first partial side view, (3CCC) a second partial side view,(3DDD) a third partial side view, (3EEE) a partial cross-sectional sideview of a piston member couple to a sliding member, (3FFF) a partialperspective view of several rotational joints, (3GGG) a partialperspective view of a rotational joint with joint members, and (3HHH) apartial perspective view of a clamp;

FIGS. 3III-3NNN show another embodiment of a laparoscopic instrumentholder according to the present invention, including (3III) aperspective view with a laparoscopic instrument retained by said holder,(3JJJ) a first partial side view, (3KKK) a second partial side view ofthe ball and socket assemblies thereof, (3LLL) a third partial side viewof the ball and socket assemblies thereof, (3MMM) a partialcross-sectional side view of portions of the ball and socket assembliesthereof, and (3NNN) a perspective view of a ball abutting a washer;

FIGS. 4A-4C show the curvilinear articulating arm assembly of FIG. 1,including (4A) a perspective view, (4B) a partial cross-sectionalperspective view, and (4C) a partial side view;

FIGS. 4D-4L show the base handle of FIG. 1, including (4D) a first sideview, (4E) a second side view, (4F) a partial perspective view of afirst set of components thereof, (4G) a partial side view of a secondset of components thereof, (4H) another partial side view of the secondset of components thereof, (4I) a front view, (4J) a back view, (4K) atop view, and (4L) a bottom view;

FIG. 4M shows a perspective view of a rail clamp for use with thepresent invention;

FIGS. 4N-4T show the free handle of FIG. 1, including (4N) a first sideperspective view showing a portion of a tensioning wire therewith, (4-O)a second side perspective view, (4P) a partial perspective view showinga first set of components thereof, (4Q) a front perspective view, (4R) aback perspective view, (4S) a top perspective view, and (4T) a bottomperspective view;

FIG. 4U shows a side perspective view of the interface lock of the freehandle of FIGS. 4N-4T;

FIG. 5 shows a perspective view of a support system according to thepresent invention;

FIGS. 6A-6C show the tray of FIG. 5, including (6A) a top view, (6B) across-section taken perpendicular to the central axis of the tray, and(6C) a partial cross-section showing detail taken at VIC; and

FIGS. 7A-7B show another embodiment of a support system including (7A) aperspective view of a curvilinear articulating arm assembly coupled to apatient support surface along a rail thereof and (7B) a perspective viewof a clamp for use in coupling the assembly to a member such as a rail.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The instrument holders described herein are particularly useful inminimally invasive surgical procedures using a laparoscope (laparoscopiccamera), which is a type of endoscope (endoscopic camera). It should beunderstood that each of the terms laparoscope, laparoscopic camera,endoscope, and endoscopic camera as individually used with respect toany particular embodiment are not meant to limit that embodiment to alaparoscopic or endoscopic context.

Referring initially to FIG. 1, an exemplary embodiment of a laparoscopicinstrument holder system 10 according to the present invention is shown.Holder system 10 includes a curvilinear articulating arm assembly 12 anda laparoscopic instrument holder 14 coupled to assembly 12 as indicatedby arrow A. As will be further described, arm assembly 12 includes aclamp 16 at a first free end thereof for coupling system 10 to astructure such as the rail 18 (shown schematically in phantom) of anoperating room table.

Turning next to FIGS. 2A-2G, a first exemplary embodiment of alaparoscopic instrument holder 100 according to the present invention isshown. Holder 100 includes a coupling portion 102 in the form of a post.Coupling portion 102 preferably is configured to be received in portion681 of free handle 662 of articulating arm assembly 12, as will bedescribed later. Holder 100 includes a body portion 104 with a shaftportion 106 extending from an end thereof and forming a first rotationaljoint. As shown in the partial cross-sectional side view of FIG. 2B,shaft portion 106 may be formed as a screw with a head 106 a, acylindrical shaft 106 b, and a threaded end 106 c that may be receivedin threaded hole 104 a in body portion 104. A first member 108 ismounted on shaft portion 106 and particularly cylindrical shaft 106 b sothat shaft portion 106 extends within a bore 108 a in first member 108.In the preferred exemplary embodiment, there is minimal frictionalresistance to rotational movement of portion 106 and first member 108with respect to one another so that these components are freelyrotatable with respect to one another. However, the tolerance betweenthe components preferably is selected to minimize other playtherebetween, and the coupling between the components preferably is suchthat minimal translation of one component with respect to the othercomponent is permitted along their central axis of rotation.

In alternate embodiments, portion 106 and first member 108 aremechanically associated with each other such that frictional engagementof these components provides limited resistance to rotational movementof portion 106 and first member 108 with respect to each other. However,the frictional engagement preferably permits relative rotation ofportion 106 and first member 108 when sufficient manual, external forceis applied as by a surgeon using holder 100 during a medical procedure.

Shaft portion 106 and first member 108 are disposed preferably at rightangles with respect to each other. First member 108 preferably includesa shaft portion 110 that may be formed as a screw with a head 110 a, acylindrical shaft 110 b, and a threaded end 110 c that may be receivedin threaded hole 108 b in first member 108. Shaft portion 110 forms asecond rotational joint.

Holder 100 further includes a second member 112 that is mounted on shaftportion 110 and particularly cylindrical shaft 110 b so that shaftportion 110 extends within a bore 112 a in second member 112. In thepreferred exemplary embodiment, there is minimal frictional resistanceto rotational movement of second member 112 and portion 110 with respectto one another so that these components are freely rotatable withrespect to one another. However, the tolerance between the componentspreferably is selected to minimize other play therebetween, and thecoupling between the components preferably is such that minimaltranslation of one component with respect to the other component ispermitted along their central axis of rotation.

In alternate embodiments, portion 110 and second member 112 aremechanically associated with each other such that frictional engagementof these components provides limited resistance to rotational movementof portion 110 and second member 112 with respect to each other.However, the frictional engagement preferably permits relative rotationof portion 110 and second member 112 when sufficient manual, externalforce is applied as by a surgeon using holder 100 during a medicalprocedure. Shaft portion 110 and second member 112 are disposedpreferably at right angles with respect to each other.

In one preferred exemplary embodiment, the joints formed by rotationalmovement of portion 106 and first member 108 with respect to each other,and by rotational movement of portion 110 and second member 112 withrespect to each other, do not lock and are disposed at about 90° to eachother. Preferably, the joints provide loose coupling between thecomponents so that they may freely rock back and forth and be angulated.

In a preferred exemplary embodiment, a stop 104 b is created at thetransition from a first circumference of body portion 104 to a smallercircumference of cylindrical shaft 106 b. Preferably, the length ofcylindrical shaft 106 b is chosen to be approximately the length of bore108 a in first member 108 so that a portion of first member 108 may beretained between head 106 a and body portion 104.

In some alternate embodiments, portion 106 optionally may be tightenedto provide substantial resistance to rotational movement of body portion104 and first member 108 with respect to one another.

Similarly, a stop 108 c is created at the transition from a firstcircumference of first member 108 to a smaller circumference ofcylindrical shaft 110 b. Stop 108 c may include washer 113 disposedbetween first member 108 and second member 112. Preferably, the lengthof cylindrical shaft 110 b is chosen to be approximately the length ofbore 112 a in second member 112 so that a portion of second member 112may be retained between head 110 a and first member 108. In thepreferred embodiment, portion 110 provides minimal frictional resistanceto rotational movement. However, in an alternate embodiment, portion 110optionally may be tightened to provide substantial resistance torotational movement of first member 108 and second member 112 withrespect to one another.

Second member 112 includes a preferably arcuate clamping portion 114. Inaddition, a pair of holes 116 extend into second member 112 and aredisposed on either side of central longitudinal axis 118 thereof. Holes116 are configured and dimensioned to receive end portions of springs120, which extend out of holes 116 and each may partially be disposed ina groove 120 a in second member 112. Movable clamping jaws 122 are“spring loaded,” with end faces 122 a abutting ends of respectivesprings 120. Thus, springs 120 bias clamping jaws 122 so that face 122 fis biased toward clamping portion 114. The slot formed between face 122f and clamping portion 114 is designed so that the spring loading aloneis sufficient to hold a laparoscope securely in place therein, but alsoto let the laparoscope rotate with sufficient frictional resistance toprevent undesired movement.

A set screw assembly 124 releasably and adjustably couples movableclamping jaws 122 to second member 112. Preferably, only slight rotationof assembly 124 is permitted, e.g., one-quarter turn clockwise orcounterclockwise. Such turning may loosen or tighten the engagement ofmovable clamping jaws 122 and finger rest portion 126 with respect toone another thus respectively permitting or hindering movement ofspring-loaded clamping jaws 122.

In alternate embodiments, set screw assembly 124 may be any component(s)or manner of fixedly coupling finger rest portion 126 to second member112.

As shown for example in FIG. 2I, a finger rest portion 126 includes acentral raised portion 126 a an a lower face 126 b. Central raisedportion 126 a is slidably received in a slot 122 b in movable clampingjaws 122. Travel of clamping jaws 122 is limited and governed by slot122 b which includes a stop portion 122 e. Slot 122 b is symmetricallydisposed with respect to axis 118. Finger rests 122 c, 122 d aredisposed at a free end of movable clamping jaws 122. Finger rest portion126 is positionally fixed with respect to second member 112, with athreaded screw 124 a of screw assembly 124 extending through hole 126 c.A knurled knob 124 b may be provided as well as a set screw 124 c (shownin FIG. 2E) extending into the shaft of screw 124 a.

Finger rest portion 126 includes a finger rest surface 126 d whichprovides sufficient surface area for accommodating a portion of a user'sfinger such as the fleshy tip of a user's thumb. Similarly, finger rests122 c, 122 d of movable clamping jaws 122 each provide sufficientsurface area for accommodating a portion of another of a user's fingers.Thus, in use, in order to adjust the spacing between arcuate clampingportion 114 and clamping face 122 f of movable clamping jaws 122, a usermay grasp finger rest portion 126 with his or her thumb disposed onsurface 126 d and two other fingers disposed on rests 122 c, 122 d, andsqueeze so that the spacing d between arcuate clamping portion 114 andclamping face 122 f is increased. Movement of clamping jaws 122 also islimited by the combined lateral distance defined by spacings d, e,particularly because of the fixed position of finger rest portion 126with respect to second member 112 as well as the maximum travel ofsurfaces 122 a of movable clamping jaws 122 with respect to surfaces 112b of second member 112.

Thus, an object such as an endoscopic camera may be releasably retainedin the space between portion 114 and clamping face 122 f. Finger restportion 126 thus serves as a quick-release for such an object. Becauseclamping end face 122 f is movable with respect to arcuate clampingportion 114 of second member 112, a variety of sizes and geometries oflaparoscopic devices such as a endoscopic camera may be releasablyretained within the region between clamping portion 114 and clamping endface 132 a, 132 b. Although a single end face 132 a is shown, otherconfigurations may be used including a bifurcated arrangement ofclamping faces, or more than two distinct end faces or extensions suchas a three “tine” fork configuration.

In use, when an object such as an endoscopic camera is secured by holder100, the rotational joints thereof are freely movable. However, once thecamera is passed through a hole in a patient's skin, the camera may bealigned to provide the desired view through the use of curvilineararticulating arm assembly 12. Because the size of the entry hole in thepatient's skin is limited, such an object disposed therein is unable tomove substantially laterally, but may be angulated as by using armassembly 12.

Arm assembly 12 and holder 100 may be disposed in a sterile sleeve coverso that a sterile environment may be maintained for example when anendoscopic camera is coupled thereto and in use. Sterile covers forholder systems such as system 10 preferably are designed to cover theentire apparatus and slide on easily when articulating arm assembly 12is in the semi-rigid “gooseneck lamp” mode (i.e. with only lever 682locked, as will be explained). Such covers, preferably formed oftransparent or semi-transparent flexible polymer as known in the art,obviate the need for much cleaning and enable full function and use ofsystem 10 in a sterile field. The scope retained by holder 100 isengaged by opening the spring-loaded slot between face 122 f andclamping portion 114 and working the mechanism of holder 100 through thecover, invaginating the cover into this slot with the scope thenretained. The cover preferably withstands repeated engage/disengagecycles and scope rotations.

A variety of materials may be used to form the holder systems of thepresent invention. For example, components may be formed of polymer suchas injection molded polymer, or metallic materials such as aluminum.Wherein springs are used, the springs for example may be formed ofsteel.

Although the center of second member 112 of holder 100 may be offset adistance d₁ from the central longitudinal axis of coupling portion 102and body portion 104, in some embodiments first member 108 may beconfigured so that the center of second member 112 may be aligned to becoaxial with the central longitudinal axis of coupling portion 102 andbody portion 104.

Turning to FIGS. 3A-3G, a second exemplary embodiment of a laparoscopicinstrument holder 300 according to the present invention is shown.Holder 300 includes a coupling portion 302 in the form of a post thatoptionally may include a circumferential groove therein (not shown).Coupling portion 302 preferably is configured to be received in portion82 of free handle 62 of articulating arm assembly 14, as will bedescribed later. Holder 300 includes a body portion 304 with apreferably cylindrical free end portion 306 forming a first rotationaljoint. In particular, a first member 308 is mounted on end portion 306so that end portion 306 extends within a bore 308 a in first member 308.In the preferred exemplary embodiment, there is minimal frictionalresistance to rotational movement of portion 306 and first member 308with respect to one another so that these components are freelyrotatable with respect to one another. However, the tolerance betweenthe components preferably is selected to minimize other playtherebetween, and the coupling between the components preferably is suchthat minimal translation of one component with respect to the othercomponent is permitted along their central axis of rotation.

In alternate embodiments, portion 306 and first member 308 aremechanically associated with each other such that frictional engagementof these components resists rotational movement of portion 306 and firstmember 308 with respect to each other. However, the frictionalengagement preferably permits relative rotation of portion 306 and firstmember 308 when sufficient manual, external force is applied as by ausing holder 300 surgeon during a medical procedure.

End portion 306 and first member 308 are disposed preferably at rightangles with respect to each other. First member 308 preferably includesa cylindrical free end portion 310 forming a second rotational joint.

Holder 300 further includes a second member 312 that is mounted on endportion 310 so that end portion 310 extends within a bore 312 a insecond member 312. Again, in the preferred exemplary embodiment, thereis minimal frictional resistance to rotational movement of portion 310and second member 312 with respect to one another so that thesecomponents are freely rotatable with respect to one another. However,the tolerance between the components preferably is selected to minimizeother play therebetween, and the coupling between the componentspreferably is such that minimal translation of one component withrespect to the other component is permitted along their central axis ofrotation.

In alternate embodiments, portion 310 and second member 312 aremechanically associated with each other such that frictional engagementof these components resists rotational movement of portion 310 andsecond member 312 with respect to each other. However, the frictionalengagement preferably permits relative rotation of portion 310 andsecond member 312 when sufficient manual, external force is applied asby a surgeon using holder 300 during a medical procedure.

End portion 310 and second member 312 are disposed preferably at rightangles with respect to each other.

Second member 312 includes a clamping portion 314 that may be arcuatesuch as U-shaped or may be another retaining shape such as V-shaped. Inaddition, a pair of holes 316 extend into second member 312 and aredisposed on either side of central longitudinal axis 318 thereof. Holes316 are configured and dimensioned to receive end portions of springs320, which extend out of holes 316. Movable clamping jaws 322 are“spring loaded,” with end faces 322 a, 322 b abutting ends of respectivesprings 320. A set screw assembly 324 and respective washer 326releasably and adjustably couples movable clamping jaws 322 to secondmember 312. As shown for example in FIG. 3E, which shows a view withscrew assembly 324 and washer 326 removed, a slot 328 guides movement ofmovable clamping jaws 322 along axis 318, with the shaft portion ofscrew assembly 324 being threadably received in central threaded hole330 in second member 312. Oval shaped slot 328 permits limited movement,with the shaft of screw assembly 324 being stopped from further movementat either end of slot 328.

Clamping end faces 332 a, 332 b that are movable with respect to arcuateclamping portion 314 of second member 312, and thus a variety of sizesand geometries of laparoscopic devices such as a endoscopic camera maybe releasably retained within the region between clamping portion 314and clamping end faces 332 a, 332 b. Although end faces 332 a, 332 b areshown in a bifurcated arrangement, other configurations may be usedincluding a single clamping face such as a larger end face 332 a or 332b, or more than two distinct end faces or extensions such as a three“tine” fork configuration.

In some embodiments, screw assembly 324 may include a threaded screw 324a, a knurled thumb portion 324 b, and a set screw 324 c (shown in FIG.3D) extending into the shaft of screw 324 a.

Holders 100, 300 thus each incorporate a system of freely articulatingjoints and that supports a clamp for a laparoscope which may be alignedand attached along the long axis of the laparoscope. The instrumentshaft may be held in alignment within the clamp opening by thespring-loaded clamp or in an alternate embodiment by using elasticband(s). The clamping mechanism of holders 100, 300 preferably is ofsufficient tension to hold the laparoscope in fixed alignment with theclamp body and yet allow rotation of the laparoscope about its long axiswithin the clamp. Proper functioning of this mechanism will allow forsimple fixation of holder 100, 300 to secure the laparoscope in a steadyposition without actually locking the individual joints in the universalsystem. Such a retention is permitted because the laparoscope shaft isfirmly attached in three dimensions to the joint at the end of holder100, 300 and also passes through a second joint (the laparoscopic port)that is fixed in two dimensions at the skin. By positioning holder 100,300, the camera may be positionally fixed unless the various frictionalresistances previously set and controlled are overcome.

This design and method allows instantaneous and free movement andinstant “re-locking” of the laparoscope position merely by relying onfrictional resistance of the arm and clamp that is easily overcome forexample by articulation by a surgeon, when desired, preferably by onehanded positioning and re-positioning. Advantageously, this laparoscopeholder system 100, 300 is very simple mechanically, yet quick, reliableand easy to use. Also, it is a very quick and simple process to engageor disengage the laparoscope when desired.

The rotational joint provided, for example, by the coupling of endportion 310 and second member 312 preferably allows a 360° range ofrotation, because the range of motion required for the laparoscope isextreme. Offsetting the points of rotation of the joints is onepreferred design solution.

In use, a straight, rod-like laparoscope extends both above and belowthe point of attachment of any clamp that is used to grasp it. Typicallythe laparoscope has power/light cords attached at the outer end thatincrease bulk in that region. Offsetting the rotational jointsadvantageously may permit better clearance between the outer end ofholder 100, 300 proximate second member 112, 312 and the bulkierexternal end of the laparoscope.

Referring next to FIGS. 3H to 3-O, a third exemplary embodiment of alaparoscopic instrument holder 400 according to the present invention isshown.

Holder 400 includes a coupling portion 402 in the form of a post thatoptionally may include a circumferential groove therein (not shown).Coupling portion 402 preferably is configured to be received in portion82 of free handle 62 of articulating arm assembly 14, as will bedescribed later. Holder 400 includes a body portion 404 with apreferably threaded hole 406 formed therein. A rotatable cradle 408 ismounted on a free end 404 a of body portion 404, with a washer 410disposed therebetween. A hole 412 with a upper broadened portion 412 ais disposed in cradle 408 and is configured and dimensioned to receivethe shaft and head of a threaded screw 414. Rotation of cradle 408 aboutlongitudinal axis 416 is permitted.

In one exemplary embodiment, body portion 404, washer 410, and cradle408 are mechanically associated with each other such that there isminimal frictional resistance to rotational movement between componentsso that cradle 408 and screw 414 are freely rotatable with respect toone another (screw 414 includes an unthreaded portion for this purpose).However, the tolerance between the components preferably is selected tominimize other play therebetween, and the coupling between thecomponents preferably is such that minimal translation of one componentwith respect to the other component is permitted along their centralaxis of rotation. In alternate embodiments, frictional engagement ofthese components resists rotational movement of these components withrespect to each other. However, the frictional engagement preferablypermits relative rotation of portion 404 and first member 408 whensufficient manual, external force is applied as by a surgeon usingholder 400 during a medical procedure.

Cradle 408 includes spaced, preferably parallel extensions 418 defininga space 420. Aligned holes 422 a, 422 b in respective extensions 418receive a rod-shaped member 424 that extends therethrough. Member 424,for example, may be press-fit in holes 422 a, 422 b so as to be fixedtherein. A first clamping portion 426 with a preferably generallyC-shaped or arcuate face 426 a is mounted on member 424, such as bymember 424 extending through a hole in portion 426. First clampingportion 426 is disposed between extensions 418 and is permitted toswivel on member 424 about swivel or rotational axis 428.

In one exemplary, preferred embodiment, there is minimal frictionalresistance to rotational movement of member 424 and first clampingportion 426 with respect to one another so that these components arefreely rotatable with respect to one another. However, the tolerancebetween the components preferably is selected to minimize other playtherebetween, and the coupling between the components preferably is suchthat minimal translation of one component with respect to the othercomponent is permitted along their central axis of rotation.

In alternate embodiments, member 424 and first clamping portion 426 maybe mechanically associated with each other such that frictionalengagement of these components resists rotational movement of thesecomponents with respect to each other. However, the frictionalengagement preferably permits relative rotation of member 424 and firstclamping portion 426 when sufficient manual, external force is appliedas by a surgeon using holder 400 during a medical procedure.

In a preferred embodiment, axes 416, 428 are oriented perpendicular toone another.

Angulation of first clamping portion 426 on member 424 permits alaparoscopic device such as a endoscopic camera, schematically shown inFIG. 3H as component 430, to be selectively positioned by a surgeon in adesired orientation.

Finally, a second clamping portion 432 is provided. Portion 432preferably is elastic, and in one preferred exemplary embodiment is aresilient rubber o-ring. Advantageously, member 424 extends outward fromextensions 418 such that a clamping portion 432 in the form of an o-ringmay be demountably coupled proximate ends thereof. Member 424 mayinclude a head or lip at each free end thereof to further assist incaptivating clamping portion 432. Thus, a component 430 may bereleasably secured to holder 400 by: resting component 430 against firstclamping portion 426 on surface 426 a, coupling a first loop section 434a of second clamping portion 432 to member 424, extending secondclamping portion 432 over component 430, and coupling a second loopsection 434 b of second clamping portion 432 to member 424.

Although a resilient o-ring is shown, other alternate embodimentsinclude for example a flexible clip.

An alternate embodiment of holder 400 is shown in FIG. 3-O. In thisembodiment, member 424 comprises a pair of opposing, aligned set screws440. Thus, clamping portion 426 swivels on an axis defined by screws440, with the screws extending in holes in clamping portion 426. Inaddition, clamping portion 426 further includes a recessed portion 442and a raised portion 444 separated by arcuate transition 446 on theouter sides of each extension 418. Movement of clamping portion 426, insome embodiments, may in part be guided by transition 446, which alsomay provide a stop to prevent over-rotation of clamping portion 426 onmember 440 but otherwise permits free and loose movement.

Another embodiment of a holder 500 is shown in FIG. 3P. Holder 500 issimilar to holder 400 with the rotatable body, however a one-pieceY-shaped cradle or yoke 508 is provided for use with an elastic clampingband as described above. Rotation is permitted about axis 510 asindicated by R₁, and additional rotation is permitted about pivot regionP disposed proximate axis 510 at and proximate the center of yoke 512.In particular, an object such as an endoscopic camera 514 my rocktransverse to axis 510, for example in a plane through axis 510 andextending into and out of the page. As shown for example in FIG. 3K, anelastic band may be retained proximate regions 512 a, 512 b, extendingover object 514. In the preferred exemplary embodiment, tines 512 arerigid. However, in some alternate embodiments, tines 512 may havelimited flexibility in positioning. In particular, a laparoscopic devicesuch as an endoscopic camera could be held in the Y-axis using theelastic band.

In yet another embodiment, shown in FIGS. 3R-3S, a holder system 550includes a holder 551 with a clamping portion 552 for receiving alaparoscopic device such as an endoscopic camera (shown schematically asobject 558). Clamping portion 552 is mounted at one end of a body 554with a split shaft 556. Holder 551 is formed of unitary construction,and for example could be mounted on body portion 560 having a preferablyunthreaded hole 562. In particular, split shaft 556 may be releasablydisposed in hole 562 so that body 554 and clamping portion 552 mayrotate with respect to body portion 560. Portion 556 a may be used toengage a suitably configured region in hole 562 (such as a ledge 564) toreleasably lock clamping system 550 in hole 562. A coupling portion 566in the form of a post may be provided as previously described withrespect to other embodiments. Body 554 may rotate about central axis 567in direction R2 as shown. In addition, further rotation may be providedby preferably rigid member 568 extending from body 554 to clampingportion 552. Member 568 forms a living hinge and permits rotation in theform of rocking transverse to axis 567 and preferably in the plane ofthe page for the orientation shown in FIG. 3S. In a preferred exemplaryembodiment, member 568 is rigid such that torsion about axis 567 issubstantially resisted. Arms 570 serve as levers upon which a user maygrasp with his or her fingers to assist in stabilizing the assemblyduring insertion or withdrawal of an object 558 such as an endoscopiccamera from clamping portion 552.

Portions of the holders described above, such as holder 551, forexample, could be made injection molded parts that could be made tofunction as described. Holder 551, for example, may be a single-use,sterile, disposable component and thus in some embodiments a steriledrape for use with system 550 need only cover body portion 560 thereofand not holder 551.

Referring next to FIGS. 3AA-3EE, another exemplary embodiment of alaparoscopic instrument holder 800 according to the present invention isshown. Holder 800 includes a coupling portion 802 in the form of a postthat optionally may include a circumferential groove therein (notshown). Coupling portion 802 preferably is configured to be received inportion 82 of free handle 62 of articulating arm assembly 14, as will bedescribed later. Holder 800 includes a body portion 804 coupled alongaxis 806 at a first rotational joint 808 to a first joint member 810. Inthe exemplary embodiment, first rotational joint 808 may permit a 360°range of rotation about axis 806.

In some embodiments, a series of rotational joints may be provided. Inthe exemplary embodiment, first member 810 is coupled along an axis 812at a second rotational joint 814 to a second joint member 816. Secondrotational joint 814 may permit a 360° range of rotation about axis 812.Second joint member 816 is coupled along an axis 818 at a thirdrotational joint 820 to a third joint member 822. Third rotational joint820 may permit a 360° range of rotation about axis 818.

Holder 800 further includes a linear length adjustment portion 824,which will be described shortly. In the exemplary embodiment, portion824 is coupled along an axis 826 at a fourth rotational joint 828 tothird joint member 822. Preferably, fourth rotational joint 828 isdisposed proximate a free end of portion 824.

In one preferred exemplary embodiment, axes 806, 812 are disposed atabout 90° with respect to each other, axes 812, 818 are disposed atabout 90° with respect to each other, and axes 818, 826 are disposed atabout 90° with respect to each other. In addition, the combination ofrotational joints 808, 814, 820, 828 permit movement in four separateplanes, it being possible for at least one pair of said planes (e.g., asdefined by joints 808, 820 or as defined by joints 814, 828) to beparallel to one another and it also being possible for there to be twopairs of parallel planes provided by the joints (e.g., as defined byjoints 808, 820 and as defined by joints 814, 828). The combination ofrotational joints 808, 814, 820, 828 also preferably permits movement infour separate planes which may be nonparallel to one another.

In the exemplary embodiment, linear length adjustment portion 824 formsa sliding mechanism in which a first sliding member 830 is coupled to asecond sliding member 832 and slidably associated with one another.Preferably, constant friction sliding is provided by members 830, 832.Also in the exemplary embodiment, members 830, 832 are restricted tomove with respect to one another along central sliding axis 834.

Member 830 for example may be coupled to a coupling portion 836 such aswith a plurality of screws 838. Preferably, coupling portion 836 isconfigured and dimensioned to be received and slide in a grooved portionor track 832 a formed in member 832. Members 830, 832 may be coupled toone another with a set screw 839 which extends through and is permittedto translate along the length of slot 840 in member 832. The shaft ofset screw 839 extends into member 834. In some embodiments, set screw839 may be tightened so that the head thereof bears against member 832to adjust the friction between the members 830, 832 with respect to eachother.

In alternate embodiments, the shaft of set screw 839 and the width ofslot 840 may be sized so that if no coupling portion 836 is provided,movement of members 830, 832 is guided along axis 834.

Another rotational joint 842 is disposed proximate the free end ofportion 824 opposite the free end at which rotational joint 828 isdisposed. Joint 842 is disposed along an axis 844. In particular, anextension 830 a of member 830 is coupled along axis 844 at rotationaljoint 842 to a joint member 846. Rotational joint 842 may permit a 360°range of rotation about axis 844. Preferably, axes 834, 844 are paralleland disposed in different planes.

Joint member 846 is coupled along an axis 848 at yet another rotationaljoint 850 to a laparoscopic device retaining portion 852. Rotationaljoint 850 may permit a 360° range of rotation about axis 848.Laparoscopic device retaining portion 852 for example may be a clampformed by a pair of jaw members 852 a, 852 b that are spring biasedtoward one another with a spring 852 c at a laparoscopic device graspingregion 852 d. Preferably, laparoscopic device grasping region 852 d issized to receive a laparoscopic device such as an endoscopic camera,shown schematically as device 854. Thus, grasping region 852 d may besized, for example, to grasp a 5 mm and/or 10 mm laparoscope. In theexemplary embodiment, axes 844, 848 are disposed at about 90° withrespect to each other.

Retaining portion 852 preferably may be used to secure the shaft portionof a laparoscopic device such as an endoscopic camera. A sterile sleevedrape may be used to cover the entire apparatus and to be imbricatedinto grasping region 852 d. Preferably, while spring-biased jaw membersare configured to hold the laparoscopic device securely, they alsopermit the device to be manually rotated about its linear axis withenough frictional resistance to prevent undesired rotational movement.

The rotational joints of holder 800 such as rotational joints 814, 816for example may be formed as follows. A threaded screw 856 is disposedwith the head thereof abutting a first washer 858 a which optionallyrests on a second washer 858 b. Washers 858 a, 858 b rest on a ledgesuch as ledge 860 in member 816. The shaft of screw 856 extends throughcoaxial holes 862, 864 in adjacent components such as members 810, 816,and is threadably received in a nut 866 that rests against a washer 868abutting ledge 870 in member 810. Members 810, 816 may be separated fromone another with a washer 872. A sleeve 874 optionally may be providedwith a hole therein through which the shaft of screw 856 extends and isguided. Sleeve 874 may be disposed proximate the head of screw 856 orremote from the head.

Thus, laparoscopic device 854 may be positioned as desired using thecombined freedom of movement provided by rotational joints 808, 814,820, 828, 842, 850, linear length adjustment portion 824, as well as therotation provided by coupling portion 802 when received in portion 82 offree handle 62 of articulating arm assembly 14.

In one preferred exemplary embodiment, holder 800 moves with fivedegrees of freedom, with the sixth degree being accommodated by rotationof laparoscopic device 854 within laparoscopic device retaining portion852. Preferably, frictional movement is provided by rotational joints808, 814, 820, 828, 842, 850, linear length adjustment portion 824, aswell as coupling portion 802 when received in portion 82 of free handle62 of articulating arm assembly 14. Preferably, the friction issufficient to hold the laparoscopic device regardless of orientation butselected so that the device is easily movable for reorientation throughmanual manipulation by a user. Higher frictional resistance to allow formovement of the working envelope may be provided by curvilineararticulating arm assembly 12, as described herein. It should be noted,however, that the ease of movement between relatively moving componentsmay be selected as desired as a function of the friction between saidcomponents. Thus, different embodiments of holder 800 may be providedwith different amounts of friction for rotational joints 808, 814, 820,828, 842, 850, linear length adjustment portion 824, as well as couplingportion 802.

Turning next to FIGS. 3FF to 3-UU, yet another exemplary embodiment of alaparoscopic instrument holder 900 according to the present invention isshown. Holder 900 includes a coupling portion 902 in the form of a postthat optionally may include a circumferential groove therein (notshown). Coupling portion 902 preferably is configured to be received inportion 82 of free handle 62 of articulating arm assembly 14, as will bedescribed later. Holder 900 includes a body portion 904 coupled alongaxis 906 at a first rotational joint 908 to a first joint member 910. Inthe exemplary embodiment, first rotational joint 908 may permit a 360°range of rotation about axis 906.

In some embodiments, a series of rotational joints may be provided. Inthe exemplary embodiment, first member 910 is coupled along an axis 912at a second rotational joint 914 to a second joint member 916. Secondrotational joint 914 may permit a 360° range of rotation about axis 912.Second joint member 916 is coupled along an axis 918 at a thirdrotational joint 920 to a linear length adjustment portion 924, whichwill be described shortly. Third rotational joint 920 may permit a 360°range of rotation about axis 918. Preferably, third rotational joint 914is disposed proximate a free end of portion 924.

In one preferred exemplary embodiment, axes 906, 912 are disposed atabout 90° with respect to each other, and axes 912, 918 are disposed atabout 90° with respect to each other. In addition, the combination ofrotational joints 908, 914, 920 permits movement in three separateplanes, it being possible for at least one pair of said planes (e.g., asdefined by joints 908, 920) to be parallel to one another. Thecombination of rotational joints 908, 914, 920 also preferably permitsmovement in three separate planes which may be nonparallel to oneanother.

In the exemplary embodiment, linear length adjustment portion 924 formsa sliding mechanism in which a first sliding member 930 is coupled to asecond sliding member 932 and slidably associated with one another.Preferably, constant friction sliding is provided by members 930, 932.Also in the exemplary embodiment, members 930, 932 are restricted tomove with respect to one another along central sliding axis 934.Advantageously, linear length adjustment portion 924 permits a user toreposition a laparoscopic device 954, for example into and out of anopening in a patient, with gross movement in a linear direction, ascompared to angulation. For example, linear length adjustment portion924 may permit about 6 inches of linear movement of a device 954 held byholder 900.

Member 930 may be provided with a first slot 930 a and member 932 may beprovided with a second slot 932 a, with each of slots 930 a, 932 a beingdisposed centrally along axis 934. First and second slots 930 a, 932 aeach may have a length S₁, S₂, respectively, along axis 934, and lengthsS₁, S₂ may be about the same as one another. In an exemplary preferredembodiment, lengths S₁, S₂ each may be about 5.5 inches. In thepreferred exemplary embodiment, members 930, 932 are coupled to eachother by coupling assemblies 936 extending from fixed positions withrespect to and proximate free ends 930 b, 932 b thereof.

Each coupling assembly 936 includes a female threaded round standoff 936a that threadably receives truss head Phillips machine screws 936 b, 936c at opposing ends thereof. Standoff 936 a extends through a plainbearing 936 d which is sized to slide and be guided in a respective slot930 a, 930 b generally constrained for movement along axis 934. Bearing936 d extends through a plastic thrust bearing 936 e positioned betweenmembers 930, 932. A member 930, 932 is captivated between plastic thrustbearing 936 e and a second plastic thrust bearing 936 f. A stainlesssteel round flat washer 936 g and a curved disc spring 936 h areprovided between bearing 936 f and the head of screw 936 c as shown,with bearing 936 d abutting washer 936 f. Spring 936 h maintains tensionbetween thrust bearings 936 e, 936 g. Finally, another curved discspring 936 i is provided and seats in a recess 930 c or 932 c of amember 930, 932, respectively. Curved disc spring 936 i allows forgreater machining tolerances for recesses 930 c, 932 c and preferablykeeps bearing 936 d in contact with washer 936 f. Coupling assemblies936 thus allow some adjustment of tensioning so that a desired level offorce permits movement of members 930, 932 with respect to one another.By loosening or tightening each of assemblies 936, frictional resistanceto sliding or telescoping of members 930, 932 with respect to each othermay be selected.

Another rotational joint 942 is disposed proximate the free end ofportion 924 opposite the free end at which rotational joint 920 isdisposed. Joint 942 is disposed along an axis 944. In particular, anextension 930 a of member 930 is coupled along axis 944 at rotationaljoint 942 to a joint member 946. Rotational joint 942 may permit a 360°range of rotation about axis 944. Preferably, axes 934, 944 are paralleland disposed in different planes.

Joint member 946 is coupled along an axis 948 at yet another rotationaljoint 950 to a laparoscopic device retaining portion 952. Rotationaljoint 950 may permit a 360° range of rotation about axis 948.Laparoscopic device retaining portion 952, for example, may be a clampformed by a pair of jaw members 952 a, 952 b with a laparoscopic devicegrasping region 952 d formed by jaw portions that are spring biasedtoward one another and handle regions that are spring biased away fromone another, the biasing accomplished using a spring 952 c. Preferably,laparoscopic device grasping region 952 d is sized to receive alaparoscopic device such as an endoscopic camera, shown schematically asdevice 954. Thus, grasping region 952 d may be sized, for example, tograsp a 5 mm and/or 10 mm laparoscope (as shown in FIG. 3-OO, twocylindrical regions are sized for this purpose). In the exemplaryembodiment, axes 944, 948 are disposed at about 90° with respect to eachother.

In order to provide sufficient clamping strength so that a laparoscopicdevice 954 may be securely and releasably retained within graspingregion 952 d of retaining portion 952, without undesired slippage orrotation, a strong spring mechanism is provided. In particular, as shownin FIGS. 3PP-3UU, spring 952 c in part elastically biases jaw members952 a, 952 b toward one another so that grasping region 952 d is in aclosed position. In the preferred exemplary embodiment, spring 952 c isa Type 302 stainless steel torsion spring providing a torque of about 21in.-lbs. (McMaster-Carr part number 9287K103 with the followingcharacteristics: 90° deflection angle clockwise wound, spring outerdiameter about 0.9 inch, wire diameter about 0.1 inch, length about 3.5inches, maximum rod outer diameter about 0.5 inch, body length/springlength at torque about 0.6 inch, and about 3.25 active coils). However,in alternate embodiments, other elastic members instead of a torsionspring may be used and other spring characteristics may be specified aslong as proper retention is provided in region 952 d. Thus, even forcesdue to power cords, etc., that may be associated with a laparoscopicdevice 954 may be sufficiently countered while device 954 is disposed ingrasping region 952 d.

Because of the substantial torque provided by spring 952 c to securelyretain a laparoscopic device 954 in grasping region 952 d, a user mayneed very significant hand strength to be able to compress the handleportions of jaw members 952 a, 952 b toward one another. To enhanceusability in view of the torque of spring 952 c, jaw member 952 a has aforked, bifurcated design with a first portion 952 a, having a U-shapedregion that receives a second portion 952 a ₂. A first pin 953 apivotally associates portions 952 a ₁ and 952 a ₂ to one another, whilea second pin 953 b pivotally associates second portion 952 a ₂ to leverlink 955. Lever link 955 is further pivotally associated with jaw member952 b with a third pin 953 c. A boss 959 a of first portion 952 a ₁ witha through hole therein is received in the through hole of a boss 959 bof jaw member 952 b and these jaw members 952 a, 952 b are coupled toone another with a screw 957 a that extends in the through hole of boss959 a and tightly abuts a coaxial set screw 957 b. Spring 952 c isdisposed about boss 959 b with one leg resting against ledge 961 a andthe other leg resting against ledge 961 b of jaw members 952 a, 952 b,respectively. During operation, in order to open grasping region 952 d,a user may grasp in one hand and squeeze (1) portion 952 a ₁ of jaw 952a which forms a first handle region and (2) jaw member 952 b which formsa second handle region. The use of a jaw member 952 a having portions952 a ₁ and 952 a ₂ as well as lever link 955 provides a mechanicaladvantage to the user when changing the size of the openings in graspingregion 952 d, e.g. to allow insertion or release of a laparoscopicdevice 954 therein. Preferably, the mechanical advantage is such thatthe turning force applied by a user to move jaw members 952 a, 952 bwith respect to one another is less than half the turning forceotherwise required for the spring 952 c.

In an exemplary preferred embodiment, when jaw members 952 a, 952 b areclosed as shown in FIGS. 3PP and 3QQ, portion 952 a ₂ is separated fromportion 952 b by an angle J of about 35°.

Retaining portion 952 preferably may be used to secure the shaft portionof a laparoscopic device such as an endoscopic camera. A sterile sleevedrape may be used to cover the entire apparatus and to be imbricatedinto grasping region 952 d. Preferably, while spring-biased jaw membersare configured to hold the laparoscopic device securely, they alsopermit the device to be manually rotated about its linear axis withenough frictional resistance to prevent undesired rotational movement.

The rotational joints of holder 900 such as rotational joints 914, 920for example may be formed as follows. An internally threaded bolt 956 isdisposed with the head thereof abutting a first washer 958 a. The washer958 a abuts a first side of a joint member such as member 916 while asecond washer 958 b abuts an opposite side of member 916 with bolt 956extending therethrough. The shaft of bolt 956 extends through hole 962and a coaxial hole in an adjacent component such as member 932. Anexternally threaded bolt 964 is threadably received in internallythreaded bolt 956.

In another exemplary embodiment, the rotational joints of holder 900such as rotational joints 908, 914, 920, 942, 950 for example may beformed with thrust bearings as follows. Although in FIGS. 3VV and 3WW anexemplary rotational joint 920 is shown, the construction of this jointalso may reflect the construction of exemplary rotational joints 908,914, 942, 950 according to this embodiment. Rotational joint 920 couplesjoint member 916 and sliding member 932 (shown in phantom). Joint 920includes a central screw 970 which is threadably received in a threadedhole 916 a in joint member 916. A Belleville or conical washer 972 abutshead 970 a of screw 970 as well as a steel ball thrust bearing 974(which for example may be carbon steel or stainless steel). Washer 972creates a spring tension to broaden the window of adjustability ofholder 900 during assembly and accommodates slight wear that may occurin operation of holder 900. In turn, thrust bearing 974 is mounted on asleeve 976 which extends from within a central opening in thrust bearing974 to within a recessed region in joint member 916. Rotational joint920 further includes a pair of washers 978, 980, preferably formed ofstainless steel, and a spacer 982 disposed therebetween, togethermounted on sleeve 976. Washer 978 abuts and preferably is bonded tojoint member 916 while washer 980 abuts and preferably is bonded tosliding member 932. Washers 978, 980 may rotate freely with respect tospacer 982. Spacer 982 for example may be formed of Delrin® AF Blend(Acetal homopolymer, PTFE-filled). As is known in the art, a highperformance miniature steel ball thrust bearing 974 for example may beformed of a pair of precision chrome-steel washers 974 a, 974 b and aball cage 974 c that is bronze or stainless steel with steel balls 974 ddisposed therein (e.g., McMaster-Carr part number 7806K63). In use,rotational joint 920 advantageously accommodates thrust loads—it canaccommodate axial thrust along the axis of the “shaft” it supports—whilealso providing desired rotational movement between joint member 916 andsliding member 932. Although a steel ball thrust bearing 972 is shown,other types of thrust bearing constructions instead may be used, andalso other types of bearings instead may be used. Moreover, althoughrotational joint 920 with thrust bearing 972 has been shown in theexemplary context of joint member 916 and sliding member 932, in thepresent embodiment such joint constructions with thrust bearings may beused in one or more, and preferably each of rotational joints 908, 914,920, 942, 950.

While holder 900 for example is shown in FIGS. 3FF and 3GG with acoupling portion 902 in the form of a post that couples to body portion904, another exemplary embodiment of a coupling portion 990 coupled tobody portion 904 is shown in FIGS. 3XX-3ZZ. Coupling portion 990 isconfigured, for example, as an adaptor for coupling holder 900 to othertypes of arrangements as known in the art. Thus, holder 900 may beattached to a variety of positioning arms not limited for example to thecurvilinear articulating arm assembly 12 in FIG. 1. Portion 990 includesa central hole 992 that receives a projection 904 a extending from anend of body portion 904. Body portion 904 and coupling portion 990 arefurther aligned with a pin 994 extending in holes in portions 904, 990that are coaxial when in alignment with one another. An interface lock996 extends into member 990 a of coupling portion 990 and is rotatablyassociated with projection 904 a of body portion 904. Interface lock 996for example may include a knurled knob portion 996 a, a cylindrical post996 b, a sleeve 996 c, and a set screw 996 d. Exemplary operation ofsuch an interface lock 996 is described elsewhere herein with respect toan interface lock 683 shown in FIG. 4U.

Thus, laparoscopic device 954 may be positioned as desired using thecombined freedom of movement provided by rotational joints 908, 914,920, 942, 950, linear length adjustment portion 924, as well as therotation provided by coupling portion 902 when received in portion 82 offree handle 62 of articulating arm assembly 14.

Preferably, frictional movement is provided by rotational joints 908,914, 920, 942, 950, linear length adjustment portion 924, as well ascoupling portion 902 when received in portion 82 of free handle 62 ofarticulating arm assembly 14, as described with respect to holder 800above. Preferably the friction is sufficient to hold the laparoscopicdevice regardless of orientation but selected so that the device iseasily movable for reorientation through manual manipulation by a user.Preferably, when a user positions a laparoscopic device 954 using holder900, the rotational and linear movements provided by the components ofholder 900 provide a generally uniform feel to the user. In other words,during manual manipulation of a device 954 coupled to holder 900, itfeels to the user as though the user encounters the same degree ofresistance to movement of the laparoscopic device 954 regardless of thedirection in which device 954 is moved/oriented. In one exemplarypreferred embodiment, rotational joints 908, 914, 920 proximate couplingportion 902 for interfacing with articulating arm assembly 14 may haveabout two times the frictional resistance to movement as rotationaljoints 942, 950 proximate laparoscopic device retaining portion 952.

Next, with reference to FIGS. 3AAA-3HHH, yet another exemplaryembodiment of a laparoscopic instrument holder 1000 according to thepresent invention is shown. As with previous embodiments, in anexemplary embodiment holder 1000 includes three rotational axes at aproximal end and two rotational axes at a distal end. Holder 1000includes a coupling portion 1002 in the form of a post. Coupling portion1002 preferably is configured to be received in portion 82 of freehandle 62 of articulating arm assembly 14, as will be described later.Holder 1000 includes a body portion 1004 coupled along axis 1006 at afirst rotational joint 1008 to a first joint member 1010. In theexemplary embodiment, first rotational joint 1008 may permit a 360°range of rotation about axis 1006.

In some embodiments, a series of rotational joints may be provided. Inthe exemplary embodiment, first member 1010 is coupled along an axis1012 at a second rotational joint 1014 to a second joint member 1016.Second rotational joint 1014 may permit a 360° range of rotation aboutaxis 1012. Second joint member 1016 is coupled along an axis 1018 at athird rotational joint 1020 to a linear length adjustment portion 1024,which will be described shortly. Third rotational joint 1020 may permita 360° range of rotation about axis 1018. Preferably, third rotationaljoint 1014 is disposed proximate a free end of portion 1024.

In one preferred exemplary embodiment, axes 1006, 1012 are disposed atabout 90° with respect to each other, and axes 1012, 1018 are disposedat about 90° with respect to each other. In addition, the combination ofrotational joints 1008, 1014, 1020 permits movement in three separateplanes, it being possible for at least one pair of said planes (e.g., asdefined by joints 1008, 1020) to be parallel to one another. Thecombination of rotational joints 1008, 1014, 1020 may permit movement inthree separate planes which may be nonparallel to one another.

In the exemplary embodiment, linear length adjustment portion 1024 formsa sliding mechanism in which a generally tubular first sliding member1030 is coupled to a generally tubular second sliding member 1032 andare slidably associated with one another. Portion 1024 forms anextendable section of holder 1000 that for example providesadjustability to the length of holder 1000. In the exemplary embodiment,members 1030, 1032 are restricted to move with respect to one anotheralong central sliding axis 1034. Advantageously, linear lengthadjustment portion 1024 permits a user to reposition a laparoscopicdevice 1054, for example into and out of an opening in a patient, withgross movement in a linear direction, as compared to angulation. Forexample, linear length adjustment portion 1024 may permit about 5 orabout 6 inches of linear movement of a device 1054 held by holder 1000.

Member 1030 preferably is received within, and telescopes with respectto member 1032. As shown in FIG. 3CCC, member 1032 is hollow and isprovided with a slot 1032 a. A roller key 1034 a is secured to member1030 with a rivet 1034 b; a piston member 1036 is coupled to a free endof member 1030 (see FIG. 3EEE) and rivet 1034 b extends in a coaxiallydisposed holes 1036 a, 1030 a in members 1036, 1030 respectively. Rollerkey 1034 a coupled to member 1030 is movable within slot 1032 a ofmember 1032 and preferably is a miniature high precision stainless steelball bearing. A cover 1037 may be secured to member 1032 over slot 1032a, for example, for safety and aesthetic reasons. Member 1032 also maybe provided with a bushing 1038 to provide support for member 1030 andto assist in preventing a sterile sleeve drape covering holder 1000 frombeing caught during movement of member 1030 with respect to member 1032.Bushing 1038 includes a plurality of fingers 1038 a disposed radiallywith respect to axis 1034. Advantageously, the use of fingers 1038 aallows an adequate interference fit to be provided with minimal dragbetween fingers 1038 a and the outer surface of member 1030 to preventthe sterile sleeve drape covering holder 1000 from being inadvertentlycaught during movement. Bushing 1038 may be formed, for example, ofDelrin® AF Blend (Acetal homopolymer, PTFE-filled).

As shown in FIG. 3EEE, piston member 1036 is spring-loaded. Inparticular, a spring 1036 b and a plunger 1036 c are disposed within ahollow cylindrical region 1036 d in piston member 1036 for movementalong axis 1036 e. Preferably axis 1036 e is disposed perpendicular toaxis 1034. By providing the spring/plunger arrangement, a consistentdrag force by may be provided for movement of members 1030, 1032 withrespect to each other as plunger 1036 c bears against the inner wall ofmember 1032. In an exemplary embodiment, the following components andmaterials may be used: spring 1036 b may be stainless, ½″ long×0.36″OD×0.032″ wire; the plunger may be 0.43″ long with an OD of 0.375 andmay be made of Delrin® AF Blend; the depth of the hole in the piston maybe ¾″ and the diameter of the piston may be 0.86″, sized for clearanceto the ID of member 1032.

Turning back to FIG. 3AAA, another rotational joint 1042 is disposedproximate the free end of member 1030 opposite the free end of member1032 at which rotational joint 1020 is disposed. Joint 1042 is disposedalong axis 1034. Rotational joint 1042 may permit a 360° range ofrotation about axis 1034. Joint member 1046 is coupled along an axis1048 at yet another rotational joint 1050 to a laparoscopic deviceretaining portion 1052. Rotational joint 1050 may permit a 360° range ofrotation about axis 1048. Laparoscopic device retaining portion 1052,for example as shown in FIG. 3HHH, may be a clamp formed by a pair ofjaw members 1052 a, 1052 b with a laparoscopic device grasping region1052 d formed by jaw portions that are spring biased toward one anotherand handle regions that are spring biased away from one another, thebiasing accomplished using a spring 1052 c. Preferably, laparoscopicdevice grasping region 1052 d is sized to receive a laparoscopic devicesuch as an endoscopic camera, shown schematically as device 1054.Preferably, grasping region 1052 d is formed by material softer thanaluminum to prevent marring or denting of surfaces of delicatelaparoscopic device 1054 which typically is thin-walled. In theexemplary preferred embodiment, polyurethane covers 1052 e are provided.Covers 1052 e for example may be formed of 85 or 95 durometerpolyurethane, permitting devices 1054 to even be twisted out of graspingregion 1052 d without damage occurring. In the exemplary embodiment,axes 1034, 1048 are disposed at about 90° with respect to each other.

Further details concerning retaining portion 1052 were previouslyprovided in the context of retaining portion 952 of a previousembodiment.

Thus, retaining portion 1052 preferably may be used to secure the shaftportion of a laparoscopic device such as an endoscopic camera. A sterilesleeve drape may be used to cover the entire apparatus and to beimbricated into grasping region 1052 d. Preferably, while spring-biasedjaw members are configured to hold the laparoscopic device securely,they also permit the device to be manually rotated about its linear axiswith enough frictional resistance to prevent undesired rotationalmovement.

An exemplary rotational joint 1014 is shown in FIG. 3GGG. Each of joints1008, 1014, 1020 for example may have the same construction, and joint1014 is described in particular. Although similar to these joints, thejoints 1042, 1050 proximate retaining portion 1052 have similarconstructions to joint 920 shown in FIGS. 3VV-3WW a previously described(e.g., with two stainless steel washers and a Delrin® AF Blend spacertherebetween that is not bonded to its surroundings). However, as willbe described, components in these various joints may be formed ofdifferent materials depending on whether the joint is located near theproximal or distal end of holder 1000.

In a preferred exemplary embodiment, joint 1014 may include a thrustbearing. Rotational joint 1014 couples joint member 1010 to joint member1016 (shown in phantom). Joint 1014 includes a central screw 1070 whichis threadably received in a threaded hole 1010 a in joint member 1010. Apair of Belleville or conical washers 1072 are disposed proximate head1070 a of screw 1070 as well as a high performance miniature steel ballthrust bearing 1074 that for example may be formed of a pair ofprecision chrome-steel washers 974 a, 974 b and a ball cage 974 c thatis bronze or stainless steel with steel balls 974 d disposed therein(e.g., McMaster-Carr part number 7806K63). In turn, thrust bearing 1074is mounted on a sleeve 1076 which extends from within a central openingin thrust bearing 1074 to within a recessed region in joint member 1016.Rotational joint 1014 further includes a washer 1078 preferably formedof stainless steel and a spacer 1082 adjacent sleeve 1076. Washer 1078abuts joint member 1010. Washer 1078 preferably is bonded to jointmember 1010 while spacer 1082 preferably is bonded to joint member 1016,it being possible for washer 1078 and spacer 1082 to rotate with respectto each other. The use of such a joint with a thrust bearing wasdescribed previously with respect to joint 920 of another embodiment,and the previous description also applies to this embodiment.

In a preferred exemplary embodiment, members 1030, 1032 are formed of6061-T6 aluminum due to the strength to weight ratio of this material.However, other materials could be used for example thin wall steel.Washers such as washers 1072 may be formed of stainless steel.

The spacers such as spacer 1082 in rotational joints 1008, 1014, 1020 atthe proximal end may be formed of Multifil™ sliding bearing materialwhich is polytetrafluoroethylene (PTFE)-based and available from GGBNorth America LLC. Advantageously, the Mutifil material has low stictionfor the present application—it shows almost no signs of “sticking” inthe operating conditions of holder 1000. On the other hand, the spacersin the rotational joints at the distal end such as joints 1042, 1050 maybe formed of Delrin® AF Blend (Acetal homopolymer, PTFE-filled).Different materials were used for the spacers at the proximal and distalends for several reasons. First, Multifil was only available in alimited range of thicknesses. Because the spacers at the proximal endwere of relatively large diameters (1⅛ inch), forces against the spacerscould be spread over this relatively large area thus allowing a“smaller” thickness of spacer to be used without risking plasticdeformation. The spacers at the distal end proximate retaining portion1052 have comparatively small diameters (¾ inch), and thus “larger”spacer thickness was needed to accommodate forces on these spacerswithout risking plastic deformation. Multifil was not available in thethickness needed for the spacers at the distal end and thus anothermaterial (Delrin® AF Blend) was chosen. Second, stiction appeared to bemore of an issue in joints at the proximal end near body portion 1004(than in joints proximate retaining portion 1052); Multifil thus was thepreferred material for addressing stiction concerns.

In an exemplary embodiment, holder 1000 may have a fully telescopedlength of about 19.5 inches as measured from the first rotational joint1008 at the proximal end proximate body portion 1004 to the center ofthe clamp jaw cover 1052 e; the unextended length of holder 1000 may beabout 14.25 inches. Thus, telescoping action may provide about 5 toabout 5.5 inches of adjustment in length of holder 1000.

Joints 1008, 1014, and 1020 each are set to about 2 ft-lbs of torque,while joint 1042 is set to about 0.8 ft-lbs of torque and joint 1050 isset to about 1.2 ft-lbs of torque. The telescoping action of members1030, 1032 may be set to have about an axial force of about 1 lb.

In use, the port in a patient into which a device 1054 is introduced mayserve as a fulcrum. The clamp of holder 1000 preferably is capable ofholding about ¼ lb. of weight from device 1054 when holder 1000 is fullyextended. Although a typical endoscopic scope may weigh about ¼ lb.,various cables associated with the scope increase the weight that mustbe supported. However, support is further provided by the port formed inthe body into which the scope is inserted, helping to assist inaccommodating the additional weight.

The rotational joints described herein, for example, may permit limitedrotation such as rotation through an angle of about 180° or an angle ofabout 270°, or may permit about 360° of rotation about an axis of therotational joint.

Next, an exemplary method of using holder 900 is described although thismethod applies to other holders described herein such as holder 1000. Inuse, the position of holder 900 should be checked for suitable workingrange near the planned camera port site. The optimum attachment pointfor the articulating arm assembly 14 for example on a surgical bedrailing should be determined after the patient is positioned and asleepand before the prep. Initially, linear length adjustment portion 924need not be telescoped, although portion 924 should be fully extendedfor draping. Assembly 14 should be oriented to near vertical forprepping and draping the patient and the arm. The drape for assembly 14preferably should be placed after the skin prep but before the finallarge procedure drape is placed. A separate skirt/half-sheet drape maybe clipped around the base of the system after the large patient drapeis placed. Assembly 14 then should be contoured closely to the patientto minimize its footprint and brought adjacent to the camera port. Inuse, the assembly 14 should be closely contoured to the patient andholder 900 disposed approximately parallel to the skin (perpendicular tothe port) to minimize interference and clutter. Also, although it ispossible that in one combination joints 910, 914, 920 may be alignedgenerally in the same plane, it is desirable to have at least one ofthese joint out of plane relative to the others to start. If thelaparoscopic device 954 is an endoscopic camera, preferably the shaft ofthe device is grasped in clamp 952 as close as possible to the camerabody. A laparoscopic device 954 coupled to holder 900 may be moved, forexample, in six degrees of freedom with the combination of rotationaljoints 942, 950 and grasping region 952 d of clamp 952 which permitsrotation of device 954 therein.

Referring now to FIGS. 3III-3NNN, a further exemplary embodiment of alaparoscopic instrument holder 1100 according to the present inventionis shown. Holder 1100 is similar to holder 1000 but instead includesball and socket joints proximate the laparoscopic device retainingportion, as will be described. Otherwise, the description of holder 1000above applies to holder 1100.

Exemplary holder 1100 includes three rotational axes at a proximal end,two rotational axes at a distal end, and separately two ball joints forrotational motion at the distal end permitting articulation with respectto an axis defined by a shaft as will be described.

Holder 1100 includes a coupling portion 1102 in the form of a post.Coupling portion 1102 preferably is configured to be received in portion82 of free handle 62 of articulating arm assembly 14, as describedseparately herein. Holder 1100 includes a body portion 1104 coupledalong axis 1106 at a first rotational joint 1108 to a first joint member1110. In the exemplary embodiment, first rotational joint 1108 maypermit a 360° range of rotation about axis 1106.

In the exemplary embodiment, first member 1110 is coupled along an axis1112 at a second rotational joint 1114 to a second joint member 1116.Second rotational joint 1114 may permit a 360° range of rotation aboutaxis 1112. Second joint member 1116 is coupled along an axis 1118 at athird rotational joint 1120 to a linear length adjustment portion 1124,as described previously with respect to linear length adjustment portion1024 of holder 1000. Third rotational joint 1120 may permit a 360° rangeof rotation about axis 1118. Preferably, third rotational joint 1114 isdisposed proximate a free end of portion 1124.

In one preferred exemplary embodiment, axes 1106, 1112 are disposed atabout 90° with respect to each other, and axes 1112, 1118 are disposedat about 90° with respect to each other. In addition, the combination ofrotational joints 1108, 1114, 1120 permits movement in three separateplanes, it being possible for at least one pair of said planes (e.g., asdefined by joints 1108, 1120) to be parallel to one another. Thecombination of rotational joints 1108, 1114, 1120 may permit movement inthree separate planes which may be nonparallel to one another.

In the exemplary embodiment, linear length adjustment portion 1124 formsa sliding mechanism for telescoping action of portions 1130, 1132 withrespect to each other, as described previously with respect to holder1000.

Another rotational joint 1142 is disposed proximate the free end ofmember 1130 opposite the free end of member 1132 at which rotationaljoint 1120 is disposed. Joint 1142 is disposed along axis 1134.Rotational joint 1142 may permit a 360° range of rotation about axis1134. Joint member 1146 is coupled along an axis 1148 at yet anotherrotational joint 1150 to a ball and socket joint portion 1152, which inturn is coupled to a laparoscopic device retaining portion 1154.Rotational joint 1150 may permit a 360° range of rotation about axis1148. Laparoscopic device retaining portion 1154 for example may besimilar to portion 1052 described previously with respect to holder1000, and is shown in FIG. 3III with a laparoscopic device 1154 aretained therein.

Turning particularly to FIGS. 3JJJ-3NNN, ball and socket joint portion1152 next will be described. In the exemplary embodiment, ball andsocket joint portion 1152 includes a pair of ball and socket joints,although in other embodiments a single ball and socket joint or morethan two ball and socket joints may be provided. Exemplary portion 1152thus includes a first socket 1155 for receiving a first ball 1156 aswell as a second socket 1158 for receiving a second ball 1160. Balls1156, 1160 are rigidly coupled to one another by a shaft 1162 receivedin opposing bores 1164, 1166, respectively. Shaft 1162 is secured toballs 1156, 1160 by pins 1168, 1170 that extend respectively in throughholes 1156 a, 1160 a. As shown in FIG. 3MMM, pins 1168, 1170 also extendthrough shaft 1162. Pins 1168, 1170 may be secured to balls 1156, 1160and/or shaft 1162 such as with a press fit.

Each of sockets 1155, 1158 have an opening 1155 a, 1158 a through whichballs 1156, 1160 respectively protrude. In use, for example, themovement of socket 1155 with respect to ball 1156 is limited by the sizeof the opening 1155 a because the internal rim defining opening 1155 alimits the movement of shaft 1162. In one preferred exemplaryembodiment, each of sockets 1155, 1158 can be angulated by as much asabout 45° transverse to shaft 1162, while sockets 1155, 1158 also mayhave a 360° range of rotation about shaft 1162.

Socket 1155 is secured to a member 1172, while similarly socket 1158 issecured to a member 1174, for example by the components being threadablycoupled to each other. First portion 1172 a preferably has outerthreading and is associated with internal threading on socket 1155.Thus, the threadable association of first portion 1172 a of member 1172and socket 1155 permits socket 1155, particularly the internal rimdefining opening 1155 a thereof, to bear against ball 1156 with a userselected degree of tightness. A similar adjustment system may be usedwith respect to socket 1158 and member 1174.

Set screws 1176 also serve to prevent rotation and for example locksocket 1155 to member 1172, as well as lock socket 1158 to member 1174.In the exemplary embodiment, three sets screws 1176 are disposed about120° apart from one another for each socket. For example, set screws1176 are threadably associated with threaded holes in socket 1155 (asshown for example in FIG. 3KKK) and bear against portion 1172 c ofmember 1172. A similar locking system may be used with respect to socket1158 and member 1174.

A series of washers also may be provided for each ball and socket pair.For example, balls 1156, 1160 each may be disposed on a washer 1178 a,1178 b. Washers 1178 a, 1178 b may have a concave, recessed portion 1179a, 1179 b of generally spherical contour for receiving a ball 1156, 1160and against which the ball may rotate. Washers 1178 a, 1178 b furthermay include a central protrusion 1180 a, 1180 b, respectively, forreceiving another washer 1182 a, 1182 b. In turn, washers 1182 a, 1182 bmay abut washers 1184 a, 1184 b. In the preferred exemplary embodiment,washers 1178 a, 1178 b are formed of aluminum and are provided to spreadload respectively on balls 1156, 1160 to avoid point loading. Washers1182 a, 1182 b may be formed for example of urethane and act as springsto maintain pressure. Finally, washers 1184 a, 1184 b may be formed forexample of stainless steel and serve to spread load on washers 1182 a,1182 b, respectively. Sockets 1155, 1158 are configured and dimensionedto retain the series of washers therein.

As can be seen in FIG. 3MMM, member 1174 may include a central hole 1186for receiving a bolt 1186 a and a recessed portion 1188 in which a nut1188 a may be threadably associated with bolt 1186 a. Clamp 1154 may besecured to member 1174 with the combination of bolt 1186 a and nut 1188a.

Although not shown in detail, member 1172 may be formed of a firstportion 1172 a coupled to a second portion 1172 b for example with acentrally disposed bolt housed therein, although alternatively theseportions may be integrally formed.

The ease of motion of sockets 1155, 1158 with respect to their balls1156, 1160, respectively, may be adjusted, for example, based on theamount of threaded engagement of a socket with respect to its associatedmember 1172, 1174.

Holders 100, 300, 400, 500, 800, 900, 1000, 1100 and clamping system 550preferably may be provided with a full cover sleeve drape. Devices 100,300, 400, 500, 550, 800, 900, 1000, 1100 may be formed as a single use,pre-sterilized device, or as a sterilizable, re-usable device, or as anon-sterile re-usable device that is covered by a sterile drape/coverwhen required. Portions of devices 100, 300, 400, 500, 550, 800, 900,1000, 1100 may be disposable.

In one exemplary, preferred embodiment, the holders of the presentinvention may be designed to create a minimum footprint or minimuminterference within the surgical field and be easily sterilized orprotected by a sterile cover. The holders preferably are long enough toreach from an attachment point on or proximate the location of a bedsiderailing to well past the skin entry port of a patient to allow for afull range of movement of the laparoscope, and to have enough pathwayvariability to clear other objects in the surgical field.

Some embodiments of holders may have several modes of operation. Onemode may be free movement with little resistance at the free end. Asecond mode may be moderate resistance at the free end. This may be mostuseful when holding an endoscopic camera. In this instance, theresistance in this second mode preferably should be sufficient tomaintain camera position in the absence of additional external forcewhile at the same time being weak enough to allow a complete range ofthree-dimensional manipulation by the surgeon or assistant using onlyone hand without the need to adjust any locking or unlocking mechanism.A third mode may be fully locked with high resistance to movement at thefree end. This mode may be particularly useful in the case where greaterforce may be required, such as retraction of an internal structure ororgan. In this circumstance, an instrument connection other than, or inaddition to the rotational joints disclosed herein, may be used.

As described above, coupling portion 302 of holder 300 and couplingportion 402 of holder 400 preferably are configured to be received inportion 82 of free handle 62 of articulating arm assembly 14. Thisarticulating arm assembly now will be described.

Turning to FIGS. 4A-4C, an exemplary preferred curvilinear articulatingarm assembly 12 is shown for use with a laparoscopic instrument holder14. Arm assembly includes a central arm 652 with a ball-sleevearrangement that forms joints. In particular, central arm 652 includes aplurality of sleeves 654 with spherical balls 656 disposed therebetweenthus forming ball and socket connections. In the exemplary embodimentshown in the figures, three balls 656 a of a first size are disposedadjacent one another proximate one end of arm 652, while the remainingballs 656 b are of a second size smaller than the first size. Sleeves654 a of a first size and sleeves 654 c of a second size smaller thanthe first size are provided for accommodating balls 656 a, 656 b,respectively, while a transition sleeve 654 b is provided intermediatesleeves 654 a, 654 c as shown for accommodating a ball 656 a on one sideand a ball 656 b on the other side thereof. Sleeves 654 are configuredand dimensioned to receive balls 656 a, 656 b at ends thereof and thuspermit articulating of sleeves with respect to each other. A tensioningwire 658 runs generally centrally through sleeves 654 and balls 656, aswill be further described shortly. Preferably, wire 658 is formed ofmetal. In an exemplary preferred embodiment, wire 658 is Type 302stainless steel wire rope, 1×19 strand, 5/32 inch diameter, with abreaking strength of 3300 lb. (McMaster-Carr part number 3458T27). Oneexemplary operation of a wire tensioning mechanism is shown anddescribed in U.S. Pat. No. 3,858,578 to Milo, which is expresslyincorporated herein by reference thereto. Preferably, curvilineararticulating arm assembly 12 may move with six degrees of freedom.

In the exemplary preferred embodiment, three additional balls 656 a andthree additional sleeves 654 a are provided to the arm assembly 12 shownin FIGS. 4A-4C, with arm assembly 12 having a fully extended(straightened) length of about 40 inches. End effector 14, for example,may add about 4 inches to the length of the arm assembly 12. In otherembodiments, other desired lengths of arm assembly 12 may beaccomplished by changing the number of balls and sleeves. For example,without the three additional balls 656 a and three additional sleeves654 a, arm assembly 12 may have a length of about 32 inches.

A base handle 660 is coupled to central arm 652 on a first end thereof,preferably adjacent a ball 656 a. In addition, a free handle 662 iscoupled to central arm 652 on a second end thereof, preferably adjacenta ball 656 b.

In one preferred exemplary embodiment, a series of larger balls 656 a isprovided proximate base handle 660 to provide stability to curvilineararticulating arm assembly 12. If for example a user such as a surgeonorients assembly 12 by grasping it proximate free handle 662,substantial bending forces may be exerted on central arm 652 proximatebase handle 660. Thus, the use of larger balls 656 a proximate basehandle 660 as compared to smaller balls 656 b proximate free handle 662provides a system with larger surface area balls near base handle 660for additional resistance to rotational movement in that portion ofcentral arm 652 and thus more stability. In alternate embodiments, morethan two different sizes of balls 656 or more than two sets of sizes ofballs 656 may be used, preferably increasing in size toward base handle660. In one alternate embodiment, each of the balls 656 in central arm652 is of increasingly larger size from free handle 662 to base handle660. The use of only two sizes of balls 656 advantageously facilitatesmanufacture and construction of arm assembly 12 because of the need toonly stock two sizes as compared to a larger number of sizes andconcomitantly greater ease of construction because only two sizes needbe assembled to form central arm 652. In yet another alternateembodiment, central arm 652 may be formed of balls 656 that all are thesame size.

Turning to FIG. 4D-4L, base handle 660 will be described. Base handle660 includes a body portion 660 a with levers 666, 668 pivotablyassociated therewith, as well as an extension 660 b that turns screwcoupling 663 and rotates in relation to and independent of body portion660 a. Base handle 660 further includes cam mechanisms 670, 672 as willbe described. Portion 663 b of coupling 663 preferably is noncircularand mechanically engages and is fixed to a like-shaped and sizednon-circular opening in portion 660 c of extension 660 b so thatrotation of extensions 660 b as by gripping and turning by a userimparts like-rotation of coupling 663 for example for demountablecoupling to clamp 16 and further coupling to a surgical table rail 18,as shown for example in FIG. 1. In the preferred exemplary embodiment,coupling 663 comprises a threaded portion 663 d which may be threadablyreceived in a threaded hole 16 a disposed in clamp 16.

Coupling 663 is disposed proximate a first free end 664 a of a stainlesssteel shaft 664 which extends therethrough and is provided with a headthat abuts a shoulder disposed in end 663 c of coupling 663. Preferably,rotation of coupling 663 is independent of rotation of shaft 664. Shaft664 preferably extends through a hole in extension 660 b.

Lever 666 is pivotably coupled to rocker arm 672 with a pin 666 a thatis disposed such that rotation of lever 666 results in eccentricmovement of rocker arm 672. As shown for example in FIGS. 4D-4E,cylindrical projections 666 b of lever 666 are received and rotate inarcuate cradle portions 660 a ₁ of body portion 660 a, while cylindricalprojections 672 b of rocker arm 672 are received and rotate in arcuatecradle portions 660 a ₂ of body portion 660 a. Rotation of lever 666toward screw coupling 663 in direction K lifts pin 666 a, and becauserocker arm 672 rests on pin 666 a, rocker arm 672 is rotated indirection L in an eccentric fashion.

As seen particularly in FIG. 4F, shaft 664 includes a threaded portion664 b the free end of which is threadably associated with a nut 665 a.Shaft 664 extends through a hole in rocker arm 672 and an unthreadedinsert 665 b with a hole therein which assists in guiding travel of rod664 along the longitudinal axis thereof. Pivoting of lever 666 indirection K causes rotation of rocker arm 672, and with shaft 664coupled to nut 665 a and nut 665 a abutting insert 665 b, rod 664 istranslated in direction M.

When coupling 663 is threaded into a like threaded hole by rotation ofextension 660 b, arm assembly 12 is relatively loosely coupled by theconnection of coupling 663 to the hole. To firmly couple arm assembly12, lever 666 may be pivoted in direction K so that threaded portion 663d of coupling 663 also moves in direction M and bears against thethreads of the hole in which it is received. The leverage created byeven slight movement of the threads against the threaded holes, on theorder of tens of thousandths of an inch, creates a wedging effect thatstrongly locks arm assembly 12 to the hole.

Lever 668 of base handle 660 also is pivotably coupled to a rocker arm670 with a pin 668 a that is disposed such that rotation of lever 668results in eccentric movement of rocker arm 670. As shown for example inFIGS. 4D-4H, cylindrical projections 668 b of lever 668 are received androtate in arcuate cradle portions 660 a ₃ of body portion 660 a, whilecylindrical projections 670 b of rocker arm 670 are received and rotatein arcuate cradle portions 660 a ₄ of body portion 660 a. Rotation oflever 668 toward screw coupling 663 in direction N lifts pin 668 a, andbecause rocker arm 670 rests on pin 668 a, rocker arm 670 is rotated indirection P in an eccentric fashion.

A forked member 676, which for example may be formed of stainless steel,is coupled to rocker 670 and includes substantially parallel prongs 676a, 676 b which mate with side walls of rocker 670 as shown. Rocker 670is pivotably associated with forked member 676, with a shaft 677extending through aligned holes in prongs 676 a, 676 b and rocker 670.Shaft 677 may be provided with a head 677 a and an external retainingring 677 b secured in a shaft groove proximate an end opposite head 677a to retain forked member 676 in association therewith and thus withrocker 670. An axial through hole 676 c is provided in tubular portion676 d of forked member 676. Tensioning wire 658 is coupled to forkedmember 676 by inserting an end portion of wire 658 in hole 676 c andswaging tubular portion 676 d so that wire 658, which extends out ofopen end 660 a ₅ of body portion 660 a, is retained by compressionwithin tubular portion 676 d.

When lever 668 is rotated in direction N, shaft 676 translates along thelongitudinal axis M₁ toward coupling 663 creating substantial tension intensioning wire 658 such that movement of curvilinear articulating armassembly 12 may be substantially resisted. In particular, actuation ofsecond lever 668 may increase or decrease the tension in wire 658 asdesired by acting on rocker arm 670. By increasing tension in wire 658,central arm 652 preferably becomes increasingly resistant to movementalthough central arm 652 preferably still may be moved through its fullrange of motion. Thus, a user may orient curvilinear articulating armassembly 12 as desired, and then increase the tension of wire 658 sothat the orientation of arm 652 is releasably fixed. Lever 668preferably has an angular range of movement about pin 668 a of up toabout 180° to permit substantial tension to be generated in tensioningwire 658.

Rockers 670, 672 preferably are associated with each other as with aspring plunger 679 extending from within one rocker 670 into a hole inthe other rocker 672. Spring plunger for example may be a stainlesssteel spring plunger with a round Delrin nose, without a lock element,with ¼″-20 threading, and 3-13 lb. end force (McMaster-Carr part number84765A33). Spring plunger 679 is used as shown because under the forceof gravity, first lever 666 may otherwise tend to move toward a closedposition with in the direction of arrow K. Instead, spring plunger 679applies pressure to rocker arm 672 to set lever 666 to tend to a defaultopen position in which shaft 664 has not otherwise been raised towardopen end 660 a ₅ of body portion 660 a.

In a preferred exemplary embodiment, rocker 670 moves with substantiallygreater eccentricity than rocker 672.

Clamp 16 for use with base handle 660 may be demountably attached tosurgical table rail 18. As previously discussed, actuation of firstlever 666 permits a user to apply a force on coupling 663 so thatmovement is resisted (e.g., in response to an 8 or 10 pound forceapplied to arm 652). In an alternate embodiment which will be furtherdescribed later, screw coupling 664 as shown in FIG. 4A proximate basehandle 660 of arm assembly 12 may be threadably associated with athreaded hole in another support surface.

A preferred exemplary embodiment of clamp 16 is shown in FIG. 4M. Clamp16 includes a threaded hole 16 a for threadably receiving threadedportion 664 of base handle 660. In addition, clamp 16 includes fixed jawportion 16 b and movable jaw portion 16 c which is pivotable about axle16 d and lockable in place using screw mechanism 16 e to firmly coupleclamp 16 to a rail 18 secured between jaw portions 16 b, 16 c.

Next turning to FIGS. 4N-4U, free handle 662 will be described. Freehandle 662 includes a wire receiving portion 680 and an end effectorreceiving portion 681. In particular, wire receiving portion 680preferably is configured to receive a ball 656 b therein, along with anend portion of wire 658. As described previously with respect to basehandle 660, a pivotable lever 682 is associated with free handle 662 andpreferably is coupled to tensioning wire 658 so that actuation of lever682 may increase or decrease the tension in wire 658 as desired byacting on rocker arm 684. By increasing tension in wire 658, central arm652 preferably becomes less flexible. Thus, a user may orientcurvilinear articulating arm assembly 12 as desired, and then increasethe tension of wire 658 so that the orientation of arm 652 is releasablyfixed. Free handle 662 has a body portion 662 a, and lever 682 isrotatable with respect thereto. An interface lock 683 also is rotatablyassociated with body portion 662 a proximate end effector receivingportion 681, as will be described shortly.

Lever 682 is pivotably coupled to rocker arm 684 with a pin 686 a thatis disposed such that rotation of lever 682 results in eccentricmovement of rocker arm 684. Cylindrical projections 682 a of lever 682are received and rotate in arcuate cradle portions 662 a ₁ of bodyportion 662 a, while cylindrical projections 684 a of rocker arm 684 arereceived and rotate in arcuate cradle portions 662 a ₂ of body portion662 a. Rotation of lever 682 toward wire receiving portion 680 indirection T lifts pin 686 a, and because rocker arm 684 rests on pin 686a, rocker arm 684 is rotated in direction U in an eccentric fashion.

Rocker arm 684 includes a hole in which a self-aligning setup washer 690(a two-piece washer with one portion that rocks in another portion) isdisposed. Setup washer 690 for example may be an 18-8 stainless steelself-aligning setup washer, ¼ inch in size, 17/64 inch inner diameter, ½inch outer diameter, and 0.250 inch to 0.281 inch thick (McMaster-Carrpart number 91944A028). A nut 692 also may abut setup washer 690 on theflat upper surface thereof and rock thereon. A threaded stud (not shown)may be swaged to the end of tensioning wire 658 opposite the endattached to forked member 676, thus coupling wire 658 to the threadedstud by compression. The threaded stud may in turn be threadablyassociated with nut 692. Wire 658 is provided with suitable length tospan from forked member 676 to nut 692.

Pivoting of lever 682 in direction T causes rotation of rocker arm 684,and with tensioning wire 658 coupled to nut 692 and nut 692 abuttinginsert 690, tension in wire 658 may be increased. In particular,actuation of lever 682 may increase or decrease the tension in wire 658as desired. By increasing tension in wire 658, central arm 652preferably becomes increasingly resistant to movement although centralarm 652 preferably still may be moved through its full range of motion.Thus, a user may orient curvilinear articulating arm assembly 12 asdesired, and then increase the tension of wire 658 so that theorientation of arm 652 is releasably fixed. Lever 668 preferably has anangular range of movement about pin 686 a of up to about 90° to permittension to be generated in tensioning wire 658.

In the preferred exemplary embodiment, actuation of lever 682 freehandle 662 permits initial tensioning of central arm 652 while stillpermitting restricted movement. And, actuation of lever 668 of basehandle 660 permits substantially greater tensioning of central arm 652while also still permitting restricted movement thereof. Advantageously,with tension created in wire 658 of central arm 652 to restrict movementthereof, the orientation of lever 668 such as with respect to a patientstill may readily be reset or adjusted before lever 666 in base handle660 is actuated to create sufficient force to prevent rotation ofthreaded portion 663 d of coupling 663 in the hole in which it isreceived.

As shown in FIG. 4U, interface lock 683 includes a knurled knob portion683 a and a cylindrical post 683 b that is provided with an arcuatecutout 683 c. Interface lock 683 is coupled to body portion 662 a withset screw 683 d which is threadably received in a threaded hole 662 b inbody portion 662 a. Set screw 683 d is further received in a slot 683 ein post 683 b to lock post 683 b in a position with arcuate cutout 683 coriented to be movable along the longitudinal axis of cylindrical post683 b. Cylindrical post 683 b may be disposed in a disengaged positionin which the axial position of post 683 b is such that arcuate cutout683 c generally follows the inner cylindrical contour of end effectorreceiving portion 681. Also, cylindrical post 683 b may be disposed inan engaged position in which the axial position of post 683 b is suchthat a portion of cylindrical post 683 b other than arcuate cutout 683 cextends past the inner cylindrical contour of end effector receivingportion 681 toward the central longitudinal axis of end effectorreceiving portion 681.

In use, in order for example to couple articulating arm assembly 12 toan end effector such as a holder 100, by capturing post 102 of holder100 in end effector receiving portion 681 of free handle 662, post 102is inserted therein while interface lock 683 is disposed in theaforementioned disengaged position. While lock 683 is in the disengagedposition, post 102 may freely rotate about the central axis of receivingportion 681. Once a desired orientation is set, lock 683 may betranslated along the major axis defined by slot 683 a so that a portionof cylindrical post 683 b of lock 683 is disposed in an engaged positionand bears against post 102. Such interference between post 102 of holder100 and post 683 b of lock 683 provides sufficient pressure so that post102 will remain fixed in rotational position and translation along thelongitudinal axis thereof against the inner cylindrical contour of endeffector receiving portion 681.

In one method of conducting a laparoscopic procedure according to thepresent invention, a curvilinear articulating arm assembly 12 with baseattachment 16 is releasably secured to a surgical table rail 18. Holdersystem 100 is demountably coupled to the free end of arm assembly 12 atfree handle 662, and a laparoscope is releasably retained in holdersystem 100 by locking it in the slot defined between face 122 f andclamping portion 114, with the laparoscope being frictionally held inthe slot in the desired rotational orientation. By articulating thelever 682 at the free end to a locked position, arm assembly 12 willhold position when left alone but can be easily repositioned with onehand without having to loosen or unclamp any other mechanisms. In thismode, arm assembly 12 should have sufficient resistance to hold thelaparoscope in position absent other external forces, much like agooseneck lamp. If locking lever 668 near the base of arm assembly 12 isalso locked then arm assembly 12 will hold position against a muchgreater force, but this lever 668 will then have to be released whenready movement of the arm/scope combination is required.

Preferably, the two rotating joints of holder 100 have complete freedomof motion and cannot be locked, and the scope is engaged by the slotdefined between face 122 f and clamping portion 114 that opens via asyringe-like spring mechanism as previously described. Free movement ofthe scope is allowed by the freely rotating joints of holder 100 thatrespond to user-selected positioning of articulating arm assembly 12while the scope is in the skin port of the patient.

In normal use, knob 124 preferably is backed off so that the springloading of movable clamping jaws 122 operates freely and the scope maybe engaged and disengaged quickly at will.

Once curvilinear articulating arm assembly 12 is fixed in position, thegeometry of the swivel joints of holder 100 in combination with thecurvilinear articulating arm assembly 12 and the laparoscope passingthrough a skin port is designed to result in reliable position holdingfor the scope, yet allow complete freedom of movement by manualrepositioning. There is no need to adjust any locking or tensioningmechanisms because of the geometry of the setup and the resistanceprovided by the arm in its “gooseneck lamp” mode.

In some methods, gross movements of the scope may be accomplished bygrabbing the articulating arm assembly 12 proximate the swivel jointsand reorient the device from that gripping point. For smaller movements,it is possible to simply grab and torque the scope itself.

In one method of use, curvilinear articulating arm assembly 12 isclosely contoured to the patient (approximately parallel to the skin) tominimize interference and clutter, and with the holder such as holder800 extended nearby the endoscopic camera port. The position of armassembly 12 is checked for suitable working range near the planned portsite. The optimum attachment point for the base of the arm assembly 12for example on a surgical bed railing is determined after the patient ispositioned and asleep and before the next preparation phase. Armassembly 12 may be oriented out of the way for prepping and draping. Anarm drape may be placed after the skin prep but before the final largeprocedure drape is placed. A separate skirt/sheet drape may be clippedaround the base after the large drape is placed. Arm assembly 12 may becontoured to the patient and brought adjacent to the camera port. Thescope may be engaged working through the drape for example by pinchingopen the spring loaded clamp of holder 800 and simply invaginating thecover with the scope into the slot. The cover preferably is tough andstretchy and withstands repeated engage/disengage cycles and scoperotation.

Each of the holder systems described herein may be used in accordancewith the aforementioned methods, regardless of spring-loading of theclamping arrangements.

Also, although an exemplary curvilinear articulating arm assembly isdescribed herein, it should be understood that other preferably,curvilinear articulating arm assemblies instead may be used whichpreferably provide six degrees of freedom of movement and permitrelatively rigid positioning such as described herein.

In some embodiments of the present invention, an instrument holdersystem such as system 10 may be coupled to a patient support other thana rail of a table. For example, referring next to FIG. 5, an exemplarysupport system 710 according to the present invention is shown with avariety of components coupled thereto. Support system 710 includes atray 712, curvilinear articulating arm assemblies 12, 716 havingrespective end effectors 100, 720, an IV pole 722, an arm board 724, andrail assemblies 726, 728. A variety of end effectors may be demountablyattached for example to articulating arm assembly 716 to assist atechnician or practitioner with a medical/imaging procedure or provideother features useful with respect to a patient. End effector 720, forexample, is configured as a self-centering abdominal probe bracket.

In one preferred exemplary embodiment, tray 712 may include two pairs ofhold regions 730, each pair being disposed proximate a free cranial end732 or free caudal end 734 of tray 712. In alternate embodiments, othernumbers of hold regions 730 may be provided such as two or more, andhold regions 730 may be provided in other regions of tray 712 such asintermediate ends 732, 734 proximate sides 736, 738. Hold regions 730may be configured as hand holds, or alternatively may be configured toreceive strapping so that tray 712 may be releasably coupled to anotherobject such as an ambulance stretcher, hospital bed, operating roomtable, or imaging scanner table. In some embodiments, handles may becoupled to tray 712. As also shown in FIG. 5, attachment regions 740 areprovided proximate sides 736, 738 for demountably coupling components aspreviously described to tray 712, as will be further described below. Inthe exemplary preferred embodiment, tray 712 is provided with thirteenattachment regions 740, although in alternate embodiments another numberof regions 740 may be provided such as at least one or tray 712 may beprovided with a surgical rail or track permitting substantial freedom ofcoupling of components along the length thereof.

Turning to FIGS. 6A-6C, additional features of tray 712 are shown.Although hand hold regions 730 are not included in the figure, suchregions may be provided as shown in FIG. 5. Attachment regions 740 areprovided in spaced arrangement along the perimeter of tray 712.Preferably, tray 712 includes a central arcuate portion 742 disposedbetween outer ledge portions 744. Preferably, regions 740 are providedon outer ledge portions 744. Central arcuate portion 742 preferably hasan upper concave surface 742 a for receiving a patient and optionally acushion (not shown) for the patient to rest against, and optionallyincludes a lower convex surface 742 b. Preferably, outer ledge portions744 include upper and lower surfaces 744 a, 744 b connected by asidewall 744 c at an angle α with respect to surface 744 b. In apreferred exemplary embodiment, sidewall 744 c is disposed at an angle αbetween about 60° and about 100°, more preferably between about 70° andabout 90°, and most preferably at about 80°.

In a preferred exemplary embodiment, tray 712 is formed of naturalfinish carbon fiber, R-51 foam core, and phenolic. Attenuationpreferably is less than 1 mm Al equivalency. Thus, tray 712 isradiolucent and suitable for use with computed axial tomography (CT)scanners. In other embodiments, tray 712 is formed of a materialsuitable for use with magnetic resonance imaging (MR) scanners. Inaddition, tray 712 preferably supports a load of 900 lbs. evenlydistributed along centerline 746, about which tray 712 may besubstantially symmetric as shown. Indicia 748 optionally may beprovided, as shown for example proximate ends 732, 734. The indicia mayfor example indicate preferred orientation of tray 712 with respect to apatient lying thereon.

In the preferred exemplary embodiment, attachment regions 740 on eachside of tray 712 are evenly spaced from each other by about 6 inchesbetween centers thereof. To accommodate patients and equipment attachedto tray 12, in one preferred embodiment tray 712 has a length of about78 inches, a width of about 21 inches, a generally uniform thickness ofabout 0.9 inch, and a height h of about 2.5 inches. Corners may beprovided with a radius R₁ of about 2 inches. In the preferred exemplaryembodiment, attachment regions 740 preferably accommodate threadedinserts, which may be formed of aluminum.

In some embodiments, tray 712 is sized to hold an adult patient, and maybe between about 180 cm and about 200 cm long. However, it will beappreciated that longer and shorter trays may be provided. In order toaccommodate an adult patient, tray 712 may support an overall weightcapacity of at least about 200 pounds, and preferably at least about 300pounds. However, if a tray 712 is sized for use with a pediatricpatient, tray 712 may only accommodate weights that do not exceed 200pounds, and more preferably do not exceed 100 pounds.

Although the surface of portion 742 of tray 712 is substantially smoothin the preferred exemplary embodiment, in alternate embodiments thesurface may be textured to provide additional resistance to motion ofobjects and/or a patient placed thereon.

Tray 712 thus is suitable for use in multiple environments, and thus may“move” with the patient from one environment (e.g., ambulance) to thenext (e.g., CT scanner) without removing a patient supported thereon.

Turning to FIGS. 7A and 7B, a curvilinear articulating arm assembly suchas assemblies 12, 716 (modified as will be described) may be coupled toa patient support surface 1200 (such as an operating room table) forexample along a rail 1202 using a clamp 1204. Clamp 1204 includes jaws1204 a, 1204 b for securing a curvilinear articulating arm assembly 12,716 to rail 1202. In particular, assemblies 12, 716 are modified toinclude an extension member 1206 which is pivotable with respect to aclamp member 1208 (that includes jaw 1204 a). Jaws 1204 a, 1204 b may betightened against rail 1202 by tightening knob 1210 which in turn drawspivotable jaw 1204 b to engage rail 1202. Extension member 1206 may bepivoted with respect to clamp member 1208 by loosening the couplingtherebetween, using knob 1212. In particular, knob 1212 is coupled to athreaded shaft (not shown) which threably engages clamp member 1208.Such an arrangement may permit angular adjustment of the curvilineararticulating arm assembly 12, 716 through a range of about 180°. Also,such a clamp 1204 advantageously permits a stable mounting of anarticulating arm with quick and easy adjustment of the positioningthereof. Thus, a laparoscopic instrument holder such as holder 1000,1100 may be coupled to a curvilinear articulating arm assembly 12, 716which further may be coupled to a clamp 1204, thus permitting the holder1000, 1100 to be secured to a patient support surface.

While various descriptions of the present invention are described above,it should be understood that the various features can be used singly orin any combination thereof. Therefore, this invention is not to belimited to only the specifically preferred embodiments depicted herein.For example, although the holders described herein are described in thecontext of laparoscopic instrument holder systems that may place acamera through a port in the skin into a working cavity, the holdersalso may be used for example in the context of procedures that examinethe interior of a bodily canal or hollow organ such as the colon,bladder, or stomach. The present invention may be applied in a varietyof fields including but not limited to general surgery, orthopedics,gynecology, urology, and cardiology. In the context of laparoscopy, thesystems of the present invention for example may be used to assist insurgical procedures involving the intestines, stomach, or gallbladderwhich may benefit from the visual inspection made possible by alaparoscope.

Further, it should be understood that variations and modificationswithin the spirit and scope of the invention may occur to those skilledin the art to which the invention pertains. Accordingly, all expedientmodifications readily attainable by one versed in the art from thedisclosure set forth herein that are within the scope and spirit of thepresent invention are to be included as further embodiments of thepresent invention. The scope of the present invention is accordinglydefined as set forth in the appended claims.

CROSS-REFERENCE TO RELATED APPLICATIONS

The benefits of Provisional Application No. 60/982,398 filed Oct. 24,2007 and entitled “System and Method for Positioning a LaparoscopicDevice” are claimed under 35 U.S.C. § 119(e), the entire contents ofthis provisional application being expressly incorporated herein byreference thereto.

This application also is a continuation-in-part of application Ser. No.11/464,804 filed Aug. 15, 2006 and entitled “System and Method forPositioning a Laparoscopic Device,” which (1) is a continuation-in-partof application Ser. No. 11/095,586 filed Apr. 1, 2005, now U.S. Pat. No.7,395,563 B2, and entitled “Support System for Use When PerformingMedical Imaging of a Patient” which claims the benefits of ProvisionalApplication No. 60/559,414 filed Apr. 2, 2004, Provisional ApplicationNo. 60/575,792 filed May 28, 2004, and Provisional Application No.60/614,593 filed Oct. 1, 2004 under 35 U.S.C. § 119(e), the priority ofwhich is claimed and the entire contents of each of these applicationsbeing expressly incorporated herein by reference thereto, and which (2)claims the benefits of Provisional Application No. 60/709,098 filed Aug.18, 2005, Provisional Application No. 60/730,853 filed Oct. 28, 2005,Provisional Application No. 60/772,863 filed Feb. 14, 2006, andProvisional Application No. 60/773,638 filed Feb. 16, 2006, eachentitled “System for Positioning a Laparoscopic Device,” as well asProvisional Application No. 60/821,692 filed Aug. 7, 2006 and entitled“System and Method for Positioning a Laparoscopic Device” under 35U.S.C. § 119(e), the priority of which is claimed and the entirecontents of these provisional applications being expressly incorporatedherein by reference thereto.

FIELD OF THE INVENTION

The invention relates to a system for positioning a laparoscopic device.In particular, the invention relates to a holder and curvilineararticulating arm for positioning a laparoscopic device such as anendoscopic camera.

BACKGROUND OF THE INVENTION

During laparoscopy, a minimally invasive surgical procedure in whichtissue for example may be removed from the abdomen or chest through asmall puncture wound, the laparoscopic surgery is performed with the aidof an endoscopic camera. The camera is placed through a port in the skininto a working cavity and may be used for example to visually examinethe interior of the cavity such as the peritoneum or surgical planes orspaces created for purposes of dissection. Typically, the cameraincludes a light source. Correct positioning and aim of the laparoscopiccamera and light throughout a procedure are fundamental to laparoscopy.

Most commonly, the endoscopic camera is held by an assistant who mustcontinually watch the video monitor and hold a steady position until thesurgeon requests a change in the field of view. Alternatively, a varietyof robotic arms have been designed to hold the camera and move forexample on voice command by the surgeon. Such systems include the AESOP®(Automated Endoscopic System for Optimal Positioning) voice controlledrobot system and the Zeus® minimal invasive surgical robot system fromComputer Motion Inc./Intuitive Surgical Inc. Mechanical/electricalservomotor controlled systems that move by foot controls, palm andfingertip controls include the LAPMAN® by MedSys s.a. of Belgium, whilea remote, manual control system da Vinci® is available from IntuitiveSurgical Inc.

In addition, a variety of known mechanical frameworks that have multipleadjustment and locking points can be used to hold an endoscopic cameraincluding a laparoscopic retractor from Thompson Surgical Instruments,the Martin Arm System from Gebrüder Martin GmbH & Co. KG, and theOmni-Tract® surgical retractors from Minnesota Scientific Inc. Thesedevices have the capability of holding other laparoscopic instruments aswell, although different connections at the instrument interface may berequired depending on the instrument and the application.

The first choice for any surgeon is to have a good human assistant, whocan continuously and accurately aim and focus the camera and light onthe moving surgical field. Unfortunately, good assistance, or anyassistance for that matter, is frequently unavailable, and the surgeonmust work solo. Also, occasions frequently arise where an assistant'shands may be occupied by other tasks, such as retraction and suction,and in these circumstances other means for holding the camera also arerequired. The alternatives for holding and positioning the camera citedabove then come into play. However, these alternatives each have one ormore troublesome drawbacks. The high end robotic arms (such as da Vinci)are expensive, have high maintenance requirements, are time consumingand cumbersome to set up and may have high cost disposable components.They also require an experienced assistant or technician to be present.The simpler, voice controlled (AESOP) or palm radio controlled (LAPMAN)robotic arms also require significant maintenance and set up time, movetoo slowly for many surgeons, and are hard to precisely control. Themechanical arms and frameworks that are available typically have toomany movable parts that require adjustment, require two hands forre-positioning, may have a large footprint near the surgical field, andare very slow to re-position because of the several joints that must beloosened and retightened.

Thompson Surgical Instruments also offers a Flexbar Scope Holder(product #42133C). This device has a clamp to the bedside railing and aset of stainless steel rods that may be clamped at a desired length withright angle clamps to position the base attachment of a curvilinearflexible arm. The arm uses a combination of a screw and cam lockingmechanism to achieve an adjustable friction lock of the arm. In thisdevice, the clamp that holds the laparoscopic camera at the free end ofthe flexible arm has limited capabilities; the clamp becomes lockeddimensionally with the arm and is not a universal joint. The design ofthe scope holder generally requires a user to loosen and then retightenthe locking mechanism for the arm whenever it is necessary to repositionthe laparoscope.

Thus, there remains a need for better holding and positioning devicesfor laparoscopic instruments in general and for the laparoscopic camera(laparoscope) in particular. In particular there is a need for a devicethat will hold a laparoscope steady when it is not in hand, may bequickly re-positioned using one hand, allows quick engagement anddisengagement to a laparoscopic instrument, and has a minimal andmovable footprint on the surgical field.

SUMMARY OF THE INVENTION

The invention relates to a system for positioning a laparoscopic device,the system having a holder. The holder includes a central portion havinga first member operatively associated with a second member, the membersselectively movable with respect to one another along a central axis,the central portion having a proximal end defined by the first memberand a distal end defined by the second member. The holder also has atleast three proximal rotational joints coupled to the first memberproximate the proximal end, at least two distal rotational jointscoupled to the second member proximate the distal end, a clampconfigured and dimensioned for retaining a laparoscopic device, and acoupling portion proximate a first of the proximal rotational joints. Afirst of the distal rotational joints is coupled to the distal end ofthe central portion and a second of the distal rotational joints iscoupled to the clamp.

In some embodiments, the members may telescope with respect to oneanother. The second member may be slidably received in the first member.The first member may have a slot and the second member may have aprotrusion, the protrusion movable within the slot. For example, theprotrusion may include a roller key. Also, in some embodiments, thesecond member may include a piston member proximate an end thereof, thepiston member disposed within the first member. The piston member may bespring-loaded with a spring oriented transverse to the central axis.

The first member may include a receiving end for receiving the secondmember and a bushing coupled to the receiving end, with the bushinghaving a plurality of fingers disposed radially with respect to thecentral axis.

Each of the proximal and distal rotational joints may include a thrustbearing which may be a steel ball thrust bearing. In addition, each ofthe proximal rotational joints may include a washer abutting a spacerand rotatable with respect to each other. In some embodiments, thespacer may be formed of a material that ispolytetrafluoroethylene-based. Each of the distal rotational joints mayinclude a washer abutting a spacer and rotatable with respect to eachother. In some embodiments, the spacer may be formed of a materialcomprising acetal homopolymer. Each of the proximal and distalrotational joints may include a spacer, each of the spacers of theproximal rotational joints having a first thickness and each of thespacers of the distal rotational joints having a second thickness, thefirst thickness being smaller than the second thickness.

The at least three proximal rotational joints may be three proximalrotational joints that each permit movement in a separate plane, and atleast two of the planes may be parallel to one another.

The first of the distal rotational joints may permit rotation about anaxis coinciding with the main axis and the second of the distalrotational joints may permit rotation about an axis transverse to themain axis. Also, the second of the distal rotational joints may permitrotation about an axis generally perpendicular to the main axis.

The clamp may include a pair of spring-biased jaw members each having acover formed of a material softer than aluminum, the clamp beingconfigured and dimensioned to retain the laparoscopic device whilecontacting the covers. For example, each cover may be formed ofpolyurethane.

The laparoscopic device may have a cylindrical portion. The first membermay be tubular. Each of the proximal and distal rotational joints mayhave a first portion rotatable with respect to a second portion about afixed axis. The first and second members may be movable with respect toeach other along the central axis but may not be rotatable with respectto each other.

The system may further include a curvilinear articulating arm, theholder being coupled to the curvilinear articulating arm. In addition,the system may further include a tray configured and dimensioned forsupporting a mammal, the curvilinear articulating arm being coupled tothe tray.

The coupling portion may include a clamp for coupling to a support,wherein the support is selected from the group consisting of a rail of atable and a rail of a bed.

Each proximal rotational joint and each distal rotational joint maypermit 360° of rotation about an axis thereof.

The invention also relates to a system for positioning a laparoscopicdevice including a curvilinear articulating arm and a holder having atleast two rotational regions and a clamping portion for receiving thelaparoscopic device, the holder being coupled to the curvilineararticulating arm. The at least two rotational regions are permitted toarticulate. The holder may further include a central portion with aselectively adjustable length along a central axis, wherein the at leasttwo rotational regions are disposed between the central portion and theclamping portion. In some embodiments, the holder further includes acentral portion with a selectively adjustable length along a centralaxis, the central portion having a proximal end and a distal end,wherein the at least two rotational regions includes at least threeproximal rotational joints disposed proximate the proximal end and atleast two distal rotational joints disposed between the distal end andthe clamping portion. The at least two rotational regions may include athrust bearing.

In addition, the invention relates to a method of positioning alaparoscopic device in a skin port of a mammal, the method including:coupling the laparoscopic device to a holder comprising a clampingportion and five rotational joints, the laparoscopic device beingpartially retained in the clamping portion; disposing the laparoscopicdevice partially within the skin port; positioning the laparoscopicdevice by selectively rotating portions of the holder with respect toone another. The method may further include positioning the laparoscopicdevice by selectively adjusting a length of the holder along a centralaxis. The holder may further include first and second membersselectively movable with respect to one another. The length may beselectively adjustable by moving the first and second members withrespect to each other. The length may be selectively adjustable bytelescoping the first member with respect to the second member. Movementof the first and second members may be restricted to linear movementalong the central axis, and the holder may be manually operated.

In some embodiments, the method may further include: coupling the holderto a curvilinear articulating arm; and articulating the curvilineararticulating arm. Also, the method may further include: coupling thecurvilinear articulating arm to a tray configured and dimensioned forsupporting the mammal. Moreover, the method may further include:coupling the curvilinear articulating arm to a support, wherein thesupport may be selected from the group consisting of a rail of a tableand a rail of a bed. The laparoscopic device may be held in a selectedposition while disposed partially within the skin port without lockingmovement of the rotational joints of the holder.

The invention also relates to a method of positioning a laparoscopicdevice in a skin port of a mammal, the method including: securing thelaparoscopic device to a holder comprising at least two rotationaljoints; coupling the holder to a curvilinear articulating arm; disposingthe laparoscopic device partially within the skin port; positioning thelaparoscopic device by selectively articulating the curvilineararticulating arm and selectively rotating portions of the holder withrespect to one another.

The method may further include: positioning the laparoscopic device byselectively adjusting a length of the holder along a central axis,wherein the holder further comprises first and second membersselectively movable with respect to one another, and wherein the lengthis selectively adjustable by moving the first and second members withrespect to each other. Also, the laparoscopic device may be held in aselected position while disposed partially within the skin port withoutlocking movement of the rotational joints of the holder.

The invention further relates to a system for positioning a laparoscopicdevice such as a camera, the system including a curvilinear articulatingarm and a holder that has at least two rotational regions as well as aclamping portion for receiving the laparoscopic device. The holder iscoupled to the curvilinear articulating arm, and wherein the at leasttwo rotational regions are permitted to articulate. The at least tworotational regions may be provided by one or more types of structuresselected from the group consisting of a rotational joint, a rockingjoint, and a living hinge. The at least two rotational regions may bepermitted to freely articulate.

The invention also relates to a method of positioning a laparoscopicdevice in a skin port of a patient, the method including: securing thedevice in a holder permitted to articulate about at least two rotationalregions; coupling the holder to a curvilinear articulating arm;disposing the device partially within the skin port; positioning thedevice by articulating the curvilinear articulating arm with the devicemoving in response to the articulation. The orientation of the device,such as a laparoscopic camera, thus may be set. The holder may bepermitted to freely articulate about at least two rotational regions.

In yet another exemplary embodiment, the invention relates to alaparoscopic instrument holder for positioning a laparoscopic deviceincluding a central portion having a first member operatively associatedwith a second member, the members selectively movable with respect toone another along a central axis, the central portion having a proximalend defined by the first member and a distal end defined by the secondmember. The holder also has at least three proximal rotational jointscoupled to the first member proximate the proximal end, at least twodistal rotational joints coupled to the second member proximate thedistal end, a first ball and socket joint coupled to a distal rotationaljoint, and a second ball and socket joint coupled to the first ball andsocket joint. In addition, the holder has a clamp configured anddimensioned for retaining a laparoscopic device, with the clamp coupledto the second ball and socket joint, and a coupling portion proximate afirst of the proximal rotational joints. In some embodiments, themembers may telescope with respect to one another and the second membermay be slidably received in the first member. Each of the proximal anddistal rotational joints may have a thrust bearing which may be a steelball thrust bearing. Each ball and socket joint may have a ball and awasher. In an exemplary embodiment, the first ball and socket joint mayhave a first ball and the second ball and socket joint may have a secondball, and the first and second balls may be rigidly coupled to eachother such as by a shaft. Each socket may have a hole with a rim forlimiting angulation of the shaft.

Another exemplary method of positioning a laparoscopic device in a skinport of a mammal includes: securing the laparoscopic device to a holdercomprising at least three proximal rotational joints, at least twodistal rotational joints, and at least two ball and socket joints;coupling the holder to a curvilinear articulating arm; disposing thelaparoscopic device partially within the skin port; positioning thelaparoscopic device by selectively articulating the curvilineararticulating arm and selectively orienting portions of the holder withrespect to one another. The laparoscopic device may be retained in aclamp, and the positioning may include angulating the clamp using theball and socket joints. The holder may further have first and secondmembers coupled to one another, and the positioning may includeselectively moving the first and second members with respect to eachother. In some embodiments, the first and second members may telescopewith respect to each other and the holder may be manually operated. Themethod may further include coupling the curvilinear articulating arm toa patient support.

The present invention further relates to a new set of devices and amethod that is particularly suited for holding, positioning andrepositioning a laparoscopic camera throughout a laparoscopic surgicalprocedure. The device includes a holder with joints for permittingrotational movement and positioning of a clamping end for securing alaparoscopic instrument. Fixed positioning and manual re-positioning maybe quickly accomplished by simply overcoming the modest frictionalresistance to movement within the devices without any mechanicaladjustments after the initial set up. The joints of the holder mayremain free to move at all times. When the holder is static itpreferably will not move, and thus, in effect, becomes self lockingbecause of the physical/mechanical relationship of the various systemcomponents including the laparoscopic instrument such as an endoscopiccamera which is secured in the holder and extending through the skin ofthe patient. In addition, the multi-modality holder has alternativefunctionality for holding and positioning other laparoscopicinstruments.

In one exemplary embodiment, the present invention comprises anarticulating arm that may be attached at one end to a surgical table,and that has the capability of movement in three dimensions (i.e., atleast three degrees (x, y and z) of freedom) at a free end. This arm hasa receiving mechanism at the free end that can accept a variety ofinstrument holding devices one of the main ones of which is alaparoscopic instrument holder for coupling to the free end of thearticulating arm and for positioning a laparoscopic device such as anendoscopic camera.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred features of the present invention are disclosed in theaccompanying drawings, wherein:

FIG. 1 is a perspective view of a laparoscopic instrument holder systemaccording to the present invention, showing an exemplary arrangementwith a holder 100 although the other exemplary holders disclosed hereinmay instead be used in such a system in place of holder 100;

FIGS. 2A-2I show a first embodiment of a laparoscopic instrument holderaccording to the present invention, including (2A) a perspective view,(2B) a partial cross-sectional front view of a portion of the holder,(2C) a front view, (2D) a back view, (2E) a first side view, (2F) asecond side view, (2G) a bottom view, (2H) a top view, and (2I) aperspective view of the mating of movable clamping jaws 122 and fingerrest portion 126;

FIGS. 3A-3G show another embodiment of a laparoscopic instrument holderaccording to the present invention, including (3A) a perspective view,(3B) a front view, (3C) a back view, (3D) a first side view, (3E) asecond side view, (3F) a bottom view, and (3G) a top view;

FIGS. 3H-3N show yet another embodiment of a laparoscopic instrumentholder according to the present invention, including (3H) a perspectiveview, (3I) a front view, (3J) a back view, (3K) a first side view, (3L)a second side view, (3M) a bottom view, and (3N) a top view;

FIG. 3O shows a perspective view of the holder of FIGS. 3H-3N with amodified member and clamping portion mounted thereon;

FIG. 3P-3Q show another embodiment of a laparoscopic instrument holderaccording to the present invention, including (3P) a perspective viewand (3Q) a front view;

FIG. 3R shows a perspective view of a portion of another clamping systemfor use with the present invention;

FIG. 3S shows a partial cross-sectional side view of the clamping systemof FIG. 3Q;

FIGS. 4A-4E show another embodiment of a laparoscopic instrument holderaccording to the present invention, including (4A) a perspective viewwith a laparoscopic instrument retained by said holder, (4B) a partialperspective view, (4C) a partial cross-sectional perspective view, (4D)another perspective view, and (4E) another partial cross-sectionalperspective view;

FIGS. 4F-4U show another embodiment of a laparoscopic instrument holderaccording to the present invention, including (4F) a perspective viewwith a laparoscopic instrument retained by said holder, (4G) a partialperspective view including several rotational joints, (4H) a partialcross-sectional perspective view including the rotational joints of theprevious figure, (4I) another partial perspective view including therotational joints of the previous figure, (4J) a partial bottom view ofthe linear length adjustment portion of the holder, (4K) a partial topview thereof, and (4L) a partial cross-sectional side view thereof, (4M)a partial cross-sectional side view of a coupling assembly, (4N) apartial perspective view of several rotational joints, (4O) anotherpartial cross-sectional perspective view of several rotational jointsand clamp, (4P) a side view of a clamp, (4Q) another side view of theclamp, and (4R to 4U) partial perspective views of the clamp;

FIGS. 4V-4W show an embodiment of a rotational joint for use withlaparoscopic instrument holders of the present invention, including (4V)a partial side view and (4W) a partial cross-sectional side view;

FIGS. 4X-4Z show another exemplary embodiment of a coupling portion foruse with laparoscopic instrument holders of the present invention,including (4X) a first side view, (4Y) a second side view, and (4Z) apartial cross-sectional perspective view;

FIGS. 5A-5H show another embodiment of a laparoscopic instrument holderaccording to the present invention, including (5A) a perspective viewwith a laparoscopic instrument retained by said holder, (5B) a firstpartial side view, (5C) a second partial side view, (5D) a third partialside view, (5E) a partial cross-sectional side view of a piston membercouple to a sliding member, (5F) a partial perspective view of severalrotational joints, (5G) a partial perspective view of a rotational jointwith joint members, and (5H) a partial perspective view of a clamp;

FIGS. 5I-5N show another embodiment of a laparoscopic instrument holderaccording to the present invention, including (5I) a perspective viewwith a laparoscopic instrument retained by said holder, (5J) a firstpartial side view, (5K) a second partial side view of the ball andsocket assemblies thereof, (5L) a third partial side view of the balland socket assemblies thereof, (5M) a partial cross-sectional side viewof portions of the ball and socket assemblies thereof, and (5N) aperspective view of a ball abutting a washer;

FIGS. 6A-6C show the curvilinear articulating arm assembly of FIG. 1,including (6A) a perspective view, (6B) a partial cross-sectionalperspective view, and (6C) a partial side view;

FIGS. 6D-6L show the base handle of FIG. 1, including (6D) a first sideview, (6E) a second side view, (6F) a partial perspective view of afirst set of components thereof, (6G) a partial side view of a secondset of components thereof, (6H) another partial side view of the secondset of components thereof, (6I) a front view, (6J) a back view, (6K) atop view, and (6L) a bottom view;

FIG. (6M) shows a perspective view of a rail clamp for use with thepresent invention;

FIGS. 6N-6T show the free handle of FIG. 1, including (6N) a first sideperspective view showing a portion of a tensioning wire therewith, (6O)a second side perspective view, (6P) a partial perspective view showinga first set of components thereof, (6Q) a front perspective view, (6R) aback perspective view, (6S) a top perspective view, and (6T) a bottomperspective view;

FIG. 6U shows a side perspective view of the interface lock of the freehandle of FIGS. 6N-6T;

FIG. 7 shows a perspective view of a support system according to thepresent invention;

FIGS. 8A-8C show the tray of FIG. 7, including (8A) a top view, (8B) across-section taken perpendicular to the central axis of the tray, and(8C) a partial cross-section showing detail taken at VIC; and

FIGS. 9A-9B show another embodiment of a support system including (9A) aperspective view of a curvilinear articulating arm assembly coupled to apatient support surface along a rail thereof and (9B) a perspective viewof a clamp for use in coupling the assembly to a member such as a rail.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The instrument holders described herein are particularly useful inminimally invasive surgical procedures using a laparoscope (laparoscopiccamera), which is a type of endoscope (endoscopic camera). It should beunderstood that each of the terms laparoscope, laparoscopic camera,endoscope, and endoscopic camera as individually used with respect toany particular embodiment are not meant to limit that embodiment to alaparoscopic or endoscopic context.

Referring initially to FIG. 1, an exemplary embodiment of a laparoscopicinstrument holder system 10 according to the present invention is shown.Holder system 10 includes a curvilinear articulating arm assembly 12 anda laparoscopic instrument holder 14 coupled to assembly 12 as indicatedby arrow A. As will be further described, arm assembly 12 includes aclamp 16 at a first free end thereof for coupling system 10 to astructure such as the rail 18 (shown schematically in phantom) of anoperating room table.

Turning next to FIGS. 2A-2G, a first exemplary embodiment of alaparoscopic instrument holder 100 according to the present invention isshown. Holder 100 includes a coupling portion 102 in the form of a post.Coupling portion 102 preferably is configured to be received in portion681 of free handle 662 of articulating arm assembly 12, as will bedescribed later. Holder 100 includes a body portion 104 with a shaftportion 106 extending from an end thereof and forming a first rotationaljoint. As shown in the partial cross-sectional side view of FIG. 2B,shaft portion 106 may be formed as a screw with a head 106 a, acylindrical shaft 106 b, and a threaded end 106 c that may be receivedin threaded hole 104 a in body portion 104. A first member 108 ismounted on shaft portion 106 and particularly cylindrical shaft 106 b sothat shaft portion 106 extends within a bore 108 a in first member 108.In the preferred exemplary embodiment, there is minimal frictionalresistance to rotational movement of portion 106 and first member 108with respect to one another so that these components are freelyrotatable with respect to one another. However, the tolerance betweenthe components preferably is selected to minimize other playtherebetween, and the coupling between the components preferably is suchthat minimal translation of one component with respect to the othercomponent is permitted along their central axis of rotation.

In alternate embodiments, portion 106 and first member 108 aremechanically associated with each other such that frictional engagementof these components provides limited resistance to rotational movementof portion 106 and first member 108 with respect to each other. However,the frictional engagement preferably permits relative rotation ofportion 106 and first member 108 when sufficient manual, external forceis applied as by a surgeon using holder 100 during a medical procedure.

Shaft portion 106 and first member 108 are disposed preferably at rightangles with respect to each other. First member 108 preferably includesa shaft portion 110 that may be formed as a screw with a head 110 a, acylindrical shaft 110 b, and a threaded end 110 c that may be receivedin threaded hole 108 b in first member 108. Shaft portion 110 forms asecond rotational joint.

Holder 100 further includes a second member 112 that is mounted on shaftportion 110 and particularly cylindrical shaft 110 b so that shaftportion 110 extends within a bore 112 a in second member 112. In thepreferred exemplary embodiment, there is minimal frictional resistanceto rotational movement of second member 112 and portion 110 with respectto one another so that these components are freely rotatable withrespect to one another. However, the tolerance between the componentspreferably is selected to minimize other play therebetween, and thecoupling between the components preferably is such that minimaltranslation of one component with respect to the other component ispermitted along their central axis of rotation.

In alternate embodiments, portion 110 and second member 112 aremechanically associated with each other such that frictional engagementof these components provides limited resistance to rotational movementof portion 110 and second member 112 with respect to each other.However, the frictional engagement preferably permits relative rotationof portion 110 and second member 112 when sufficient manual, externalforce is applied as by a surgeon using holder 100 during a medicalprocedure. Shaft portion 110 and second member 112 are disposedpreferably at right angles with respect to each other.

In one preferred exemplary embodiment, the joints formed by rotationalmovement of portion 106 and first member 108 with respect to each other,and by rotational movement of portion 110 and second member 112 withrespect to each other, do not lock and are disposed at about 90° to eachother. Preferably, the joints provide loose coupling between thecomponents so that they may freely rock back and forth and be angulated.

In a preferred exemplary embodiment, a stop 104 b is created at thetransition from a first circumference of body portion 104 to a smallercircumference of cylindrical shaft 106 b. Preferably, the length ofcylindrical shaft 106 b is chosen to be approximately the length of bore108 a in first member 108 so that a portion of first member 108 may beretained between head 106 a and body portion 104.

In some alternate embodiments, portion 106 optionally may be tightenedto provide substantial resistance to rotational movement of body portion104 and first member 108 with respect to one another.

Similarly, a stop 108 c is created at the transition from a firstcircumference of first member 108 to a smaller circumference ofcylindrical shaft 110 b. Stop 108 c may include washer 113 disposedbetween first member 108 and second member 112. Preferably, the lengthof cylindrical shaft 110 b is chosen to be approximately the length ofbore 112 a in second member 112 so that a portion of second member 112may be retained between head 110 a and first member 108. In thepreferred embodiment, portion 110 provides minimal frictional resistanceto rotational movement. However, in an alternate embodiment, portion 110optionally may be tightened to provide substantial resistance torotational movement of first member 108 and second member 112 withrespect to one another.

Second member 112 includes a preferably arcuate clamping portion 114. Inaddition, a pair of holes 116 extend into second member 112 and aredisposed on either side of central longitudinal axis 118 thereof. Holes116 are configured and dimensioned to receive end portions of springs120, which extend out of holes 116 and each may partially be disposed ina groove 120 a in second member 112. Movable clamping jaws 122 are“spring loaded,” with end faces 122 a abutting ends of respectivesprings 120. Thus, springs 120 bias clamping jaws 122 so that face 122 fis biased toward clamping portion 114. The slot formed between face 122f and clamping portion 114 is designed so that the spring loading aloneis sufficient to hold a laparoscope securely in place therein, but alsoto let the laparoscope rotate with sufficient frictional resistance toprevent undesired movement.

A set screw assembly 124 releasably and adjustably couples movableclamping jaws 122 to second member 112. Preferably, only slight rotationof assembly 124 is permitted, e.g., one-quarter turn clockwise orcounterclockwise. Such turning may loosen or tighten the engagement ofmovable clamping jaws 122 and finger rest portion 126 with respect toone another thus respectively permitting or hindering movement ofspring-loaded clamping jaws 122.

In alternate embodiments, set screw assembly 124 may be any component(s)or manner of fixedly coupling finger rest portion 126 to second member112.

As shown for example in FIG. 2I, a finger rest portion 126 includes acentral raised portion 126 a an a lower face 126 b. Central raisedportion 126 a is slidably received in a slot 122 b in movable clampingjaws 122. Travel of clamping jaws 122 is limited and governed by slot122 b which includes a stop portion 122 e. Slot 122 b is symmetricallydisposed with respect to axis 118. Finger rests 122 c, 122 d aredisposed at a free end of movable clamping jaws 122. Finger rest portion126 is positionally fixed with respect to second member 112, with athreaded screw 124 a of screw assembly 124 extending through hole 126 c.A knurled knob 124 b may be provided as well as a set screw 124 c (shownin FIG. 2E) extending into the shaft of screw 124 a.

Finger rest portion 126 includes a finger rest surface 126 d whichprovides sufficient surface area for accommodating a portion of a user'sfinger such as the fleshy tip of a user's thumb. Similarly, finger rests122 c, 122 d of movable clamping jaws 122 each provide sufficientsurface area for accommodating a portion of another of a user's fingers.Thus, in use, in order to adjust the spacing between arcuate clampingportion 114 and clamping face 122 f of movable clamping jaws 122, a usermay grasp finger rest portion 126 with his or her thumb disposed onsurface 126 d and two other fingers disposed on rests 122 c, 122 d, andsqueeze so that the spacing d between arcuate clamping portion 114 andclamping face 122 f is increased. Movement of clamping jaws 122 also islimited by the combined lateral distance defined by spacings d, e,particularly because of the fixed position of finger rest portion 126with respect to second member 112 as well as the maximum travel ofsurfaces 122 a of movable clamping jaws 122 with respect to surfaces 112b of second member 112.

Thus, an object such as an endoscopic camera may be releasably retainedin the space between portion 114 and clamping face 122 f. Finger restportion 126 thus serves as a quick-release for such an object. Becauseclamping end face 122 f is movable with respect to arcuate clampingportion 114 of second member 112, a variety of sizes and geometries oflaparoscopic devices such as a endoscopic camera may be releasablyretained within the region between clamping portion 114 and clamping endface 132 a, 132 b. Although a single end face 132 a is shown, otherconfigurations may be used including a bifurcated arrangement ofclamping faces, or more than two distinct end faces or extensions suchas a three “tine” fork configuration.

In use, when an object such as an endoscopic camera is secured by holder100, the rotational joints thereof are freely movable. However, once thecamera is passed through a hole in a patient's skin, the camera may bealigned to provide the desired view through the use of curvilineararticulating arm assembly 12. Because the size of the entry hole in thepatient's skin is limited, such an object disposed therein is unable tomove substantially laterally, but may be angulated as by using armassembly 12.

Arm assembly 12 and holder 100 may be disposed in a sterile sleeve coverso that a sterile environment may be maintained for example when anendoscopic camera is coupled thereto and in use. Sterile covers forholder systems such as system 10 preferably are designed to cover theentire apparatus and slide on easily when articulating arm assembly 12is in the semi-rigid “gooseneck lamp” mode (i.e. with only lever 682locked, as will be explained). Such covers, preferably formed oftransparent or semi-transparent flexible polymer as known in the art,obviate the need for much cleaning and enable full function and use ofsystem 10 in a sterile field. The scope retained by holder 100 isengaged by opening the spring-loaded slot between face 122 f andclamping portion 114 and working the mechanism of holder 100 through thecover, invaginating the cover into this slot with the scope thenretained. The cover preferably withstands repeated engage/disengagecycles and scope rotations.

A variety of materials may be used to form the holder systems of thepresent invention. For example, components may be formed of polymer suchas injection molded polymer, or metallic materials such as aluminum.Wherein springs are used, the springs for example may be formed ofsteel.

Although the center of second member 112 of holder 100 may be offset adistance d₁ from the central longitudinal axis of coupling portion 102and body portion 104, in some embodiments first member 108 may beconfigured so that the center of second member 112 may be aligned to becoaxial with the central longitudinal axis of coupling portion 102 andbody portion 104.

Turning to FIGS. 3A-3G, a second exemplary embodiment of a laparoscopicinstrument holder 300 according to the present invention is shown.Holder 300 includes a coupling portion 302 in the form of a post thatoptionally may include a circumferential groove therein (not shown).Coupling portion 302 preferably is configured to be received in portion82 of free handle 62 of articulating arm assembly 14, as will bedescribed later. Holder 300 includes a body portion 304 with apreferably cylindrical free end portion 306 forming a first rotationaljoint. In particular, a first member 308 is mounted on end portion 306so that end portion 306 extends within a bore 308 a in first member 308.In the preferred exemplary embodiment, there is minimal frictionalresistance to rotational movement of portion 306 and first member 308with respect to one another so that these components are freelyrotatable with respect to one another. However, the tolerance betweenthe components preferably is selected to minimize other playtherebetween, and the coupling between the components preferably is suchthat minimal translation of one component with respect to the othercomponent is permitted along their central axis of rotation.

In alternate embodiments, portion 306 and first member 308 aremechanically associated with each other such that frictional engagementof these components resists rotational movement of portion 306 and firstmember 308 with respect to each other. However, the frictionalengagement preferably permits relative rotation of portion 306 and firstmember 308 when sufficient manual, external force is applied as by ausing holder 300 surgeon during a medical procedure.

End portion 306 and first member 308 are disposed preferably at rightangles with respect to each other. First member 308 preferably includesa cylindrical free end portion 310 forming a second rotational joint.

Holder 300 further includes a second member 312 that is mounted on endportion 310 so that end portion 310 extends within a bore 312 a insecond member 312. Again, in the preferred exemplary embodiment, thereis minimal frictional resistance to rotational movement of portion 310and second member 312 with respect to one another so that thesecomponents are freely rotatable with respect to one another. However,the tolerance between the components preferably is selected to minimizeother play therebetween, and the coupling between the componentspreferably is such that minimal translation of one component withrespect to the other component is permitted along their central axis ofrotation.

In alternate embodiments, portion 310 and second member 312 aremechanically associated with each other such that frictional engagementof these components resists rotational movement of portion 310 andsecond member 312 with respect to each other. However, the frictionalengagement preferably permits relative rotation of portion 310 andsecond member 312 when sufficient manual, external force is applied asby a surgeon using holder 300 during a medical procedure.

End portion 310 and second member 312 are disposed preferably at rightangles with respect to each other.

Second member 312 includes a clamping portion 314 that may be arcuatesuch as U-shaped or may be another retaining shape such as V-shaped. Inaddition, a pair of holes 316 extend into second member 312 and aredisposed on either side of central longitudinal axis 318 thereof. Holes316 are configured and dimensioned to receive end portions of springs320, which extend out of holes 316. Movable clamping jaws 322 are“spring loaded,” with end faces 322 a, 322 b abutting ends of respectivesprings 320. A set screw assembly 324 and respective washer 326releasably and adjustably couples movable clamping jaws 322 to secondmember 312. As shown for example in FIG. 3E, which shows a view withscrew assembly 324 and washer 326 removed, a slot 328 guides movement ofmovable clamping jaws 322 along axis 318, with the shaft portion ofscrew assembly 324 being threadably received in central threaded hole330 in second member 312. Oval shaped slot 328 permits limited movement,with the shaft of screw assembly 324 being stopped from further movementat either end of slot 328.

Clamping end faces 332 a, 332 b that are movable with respect to arcuateclamping portion 314 of second member 312, and thus a variety of sizesand geometries of laparoscopic devices such as a endoscopic camera maybe releasably retained within the region between clamping portion 314and clamping end faces 332 a, 332 b. Although end faces 332 a, 332 b areshown in a bifurcated arrangement, other configurations may be usedincluding a single clamping face such as a larger end face 332 a or 332b, or more than two distinct end faces or extensions such as a three“tine” fork configuration.

In some embodiments, screw assembly 324 may include a threaded screw 324a, a knurled thumb portion 324 b, and a set screw 324 c (shown in FIG.3D) extending into the shaft of screw 324 a.

Holders 100, 300 thus each incorporate a system of freely articulatingjoints and that supports a clamp for a laparoscope which may be alignedand attached along the long axis of the laparoscope. The instrumentshaft may be held in alignment within the clamp opening by thespring-loaded clamp or in an alternate embodiment by using elasticband(s). The clamping mechanism of holders 100, 300 preferably is ofsufficient tension to hold the laparoscope in fixed alignment with theclamp body and yet allow rotation of the laparoscope about its long axiswithin the clamp. Proper functioning of this mechanism will allow forsimple fixation of holder 100, 300 to secure the laparoscope in a steadyposition without actually locking the individual joints in the universalsystem. Such a retention is permitted because the laparoscope shaft isfirmly attached in three dimensions to the joint at the end of holder100, 300 and also passes through a second joint (the laparoscopic port)that is fixed in two dimensions at the skin. By positioning holder 100,300, the camera may be positionally fixed unless the various frictionalresistances previously set and controlled are overcome.

This design and method allows instantaneous and free movement andinstant “re-locking” of the laparoscope position merely by relying onfrictional resistance of the arm and clamp that is easily overcome forexample by articulation by a surgeon, when desired, preferably by onehanded positioning and re-positioning. Advantageously, this laparoscopeholder system 100, 300 is very simple mechanically, yet quick, reliableand easy to use. Also, it is a very quick and simple process to engageor disengage the laparoscope when desired.

The rotational joint provided, for example, by the coupling of endportion 310 and second member 312 preferably allows a 360° range ofrotation, because the range of motion required for the laparoscope isextreme. Offsetting the points of rotation of the joints is onepreferred design solution.

In use, a straight, rod-like laparoscope extends both above and belowthe point of attachment of any clamp that is used to grasp it. Typicallythe laparoscope has power/light cords attached at the outer end thatincrease bulk in that region. Offsetting the rotational jointsadvantageously may permit better clearance between the outer end ofholder 100, 300 proximate second member 112, 312 and the bulkierexternal end of the laparoscope.

Referring next to FIGS. 3H to 3O, a third exemplary embodiment of alaparoscopic instrument holder 400 according to the present invention isshown.

Holder 400 includes a coupling portion 402 in the form of a post thatoptionally may include a circumferential groove therein (not shown).Coupling portion 402 preferably is configured to be received in portion82 of free handle 62 of articulating arm assembly 14, as will bedescribed later. Holder 400 includes a body portion 404 with apreferably threaded hole 406 formed therein. A rotatable cradle 408 ismounted on a free end 404 a of body portion 404, with a washer 410disposed therebetween. A hole 412 with a upper broadened portion 412 ais disposed in cradle 408 and is configured and dimensioned to receivethe shaft and head of a threaded screw 414. Rotation of cradle 408 aboutlongitudinal axis 416 is permitted.

In one exemplary embodiment, body portion 404, washer 410, and cradle408 are mechanically associated with each other such that there isminimal frictional resistance to rotational movement between componentsso that cradle 408 and screw 414 are freely rotatable with respect toone another (screw 414 includes an unthreaded portion for this purpose).However, the tolerance between the components preferably is selected tominimize other play therebetween, and the coupling between thecomponents preferably is such that minimal translation of one componentwith respect to the other component is permitted along their centralaxis of rotation. In alternate embodiments, frictional engagement ofthese components resists rotational movement of these components withrespect to each other. However, the frictional engagement preferablypermits relative rotation of portion 404 and first member 408 whensufficient manual, external force is applied as by a surgeon usingholder 400 during a medical procedure.

Cradle 408 includes spaced, preferably parallel extensions 418 defininga space 420. Aligned holes 422 a, 422 b in respective extensions 418receive a rod-shaped member 424 that extends therethrough. Member 424,for example, may be press-fit in holes 422 a, 422 b so as to be fixedtherein. A first clamping portion 426 with a preferably generallyC-shaped or arcuate face 426 a is mounted on member 424, such as bymember 424 extending through a hole in portion 426. First clampingportion 426 is disposed between extensions 418 and is permitted toswivel on member 424 about swivel or rotational axis 428.

In one exemplary, preferred embodiment, there is minimal frictionalresistance to rotational movement of member 424 and first clampingportion 426 with respect to one another so that these components arefreely rotatable with respect to one another. However, the tolerancebetween the components preferably is selected to minimize other playtherebetween, and the coupling between the components preferably is suchthat minimal translation of one component with respect to the othercomponent is permitted along their central axis of rotation.

In alternate embodiments, member 424 and first clamping portion 426 maybe mechanically associated with each other such that frictionalengagement of these components resists rotational movement of thesecomponents with respect to each other. However, the frictionalengagement preferably permits relative rotation of member 424 and firstclamping portion 426 when sufficient manual, external force is appliedas by a surgeon using holder 400 during a medical procedure.

In a preferred embodiment, axes 416, 428 are oriented perpendicular toone another.

Angulation of first clamping portion 426 on member 424 permits alaparoscopic device such as a endoscopic camera, schematically shown inFIG. 3H as component 430, to be selectively positioned by a surgeon in adesired orientation.

Finally, a second clamping portion 432 is provided. Portion 432preferably is elastic, and in one preferred exemplary embodiment is aresilient rubber o-ring. Advantageously, member 424 extends outward fromextensions 418 such that a clamping portion 432 in the form of an o-ringmay be demountably coupled proximate ends thereof. Member 424 mayinclude a head or lip at each free end thereof to further assist incaptivating clamping portion 432. Thus, a component 430 may bereleasably secured to holder 400 by: resting component 430 against firstclamping portion 426 on surface 426 a, coupling a first loop section 434a of second clamping portion 432 to member 424, extending secondclamping portion 432 over component 430, and coupling a second loopsection 434 b of second clamping portion 432 to member 424.

Although a resilient o-ring is shown, other alternate embodimentsinclude for example a flexible clip.

An alternate embodiment of holder 400 is shown in FIG. 3O. In thisembodiment, member 424 comprises a pair of opposing, aligned set screws440. Thus, clamping portion 426 swivels on an axis defined by screws440, with the screws extending in holes in clamping portion 426. Inaddition, clamping portion 426 further includes a recessed portion 442and a raised portion 444 separated by arcuate transition 446 on theouter sides of each extension 418. Movement of clamping portion 426, insome embodiments, may in part be guided by transition 446, which alsomay provide a stop to prevent over-rotation of clamping portion 426 onmember 440 but otherwise permits free and loose movement.

Another embodiment of a holder 500 is shown in FIG. 3P. Holder 500 issimilar to holder 400 with the rotatable body, however a one-pieceY-shaped cradle or yoke 508 is provided for use with an elastic clampingband as described above. Rotation is permitted about axis 510 asindicated by R₁, and additional rotation is permitted about pivot regionP disposed proximate axis 510 at and proximate the center of yoke 512.In particular, an object such as an endoscopic camera 514 my rocktransverse to axis 510, for example in a plane through axis 510 andextending into and out of the page. As shown for example in FIG. 3K, anelastic band may be retained proximate regions 512 a, 512 b, extendingover object 514. In the preferred exemplary embodiment, tines 512 arerigid. However, in some alternate embodiments, tines 512 may havelimited flexibility in positioning. In particular, a laparoscopic devicesuch as an endoscopic camera could be held in the Y-axis using theelastic band.

In yet another embodiment, shown in FIGS. 3R-3S, a holder system 550includes a holder 551 with a clamping portion 552 for receiving alaparoscopic device such as an endoscopic camera (shown schematically asobject 558). Clamping portion 552 is mounted at one end of a body 554with a split shaft 556. Holder 551 is formed of unitary construction,and for example could be mounted on body portion 560 having a preferablyunthreaded hole 562. In particular, split shaft 556 may be releasablydisposed in hole 562 so that body 554 and clamping portion 552 mayrotate with respect to body portion 560. Portion 556 a may be used toengage a suitably configured region in hole 562 (such as a ledge 564) toreleasably lock clamping system 550 in hole 562. A coupling portion 566in the form of a post may be provided as previously described withrespect to other embodiments. Body 554 may rotate about central axis 567in direction R2 as shown. In addition, further rotation may be providedby preferably rigid member 568 extending from body 554 to clampingportion 552. Member 568 forms a living hinge and permits rotation in theform of rocking transverse to axis 567 and preferably in the plane ofthe page for the orientation shown in FIG. 3S. In a preferred exemplaryembodiment, member 568 is rigid such that torsion about axis 567 issubstantially resisted. Arms 570 serve as levers upon which a user maygrasp with his or her fingers to assist in stabilizing the assemblyduring insertion or withdrawal of an object 558 such as an endoscopiccamera from clamping portion 552.

Portions of the holders described above, such as holder 551, forexample, could be made injection molded parts that could be made tofunction as described. Holder 551, for example, may be a single-use,sterile, disposable component and thus in some embodiments a steriledrape for use with system 550 need only cover body portion 560 thereofand not holder 551.

Referring next to FIGS. 4A-4E, another exemplary embodiment of alaparoscopic instrument holder 800 according to the present invention isshown. Holder 800 includes a coupling portion 802 in the form of a postthat optionally may include a circumferential groove therein (notshown). Coupling portion 802 preferably is configured to be received inportion 82 of free handle 62 of articulating arm assembly 14, as will bedescribed later. Holder 800 includes a body portion 804 coupled alongaxis 806 at a first rotational joint 808 to a first joint member 810. Inthe exemplary embodiment, first rotational joint 808 may permit a 360°range of rotation about axis 806.

In some embodiments, a series of rotational joints may be provided. Inthe exemplary embodiment, first member 810 is coupled along an axis 812at a second rotational joint 814 to a second joint member 816. Secondrotational joint 814 may permit a 360° range of rotation about axis 812.Second joint member 816 is coupled along an axis 818 at a thirdrotational joint 820 to a third joint member 822. Third rotational joint820 may permit a 360° range of rotation about axis 818.

Holder 800 further includes a linear length adjustment portion 824,which will be described shortly. In the exemplary embodiment, portion824 is coupled along an axis 826 at a fourth rotational joint 828 tothird joint member 822. Preferably, fourth rotational joint 828 isdisposed proximate a free end of portion 824.

In one preferred exemplary embodiment, axes 806, 812 are disposed atabout 90° with respect to each other, axes 812, 818 are disposed atabout 90° with respect to each other, and axes 818, 826 are disposed atabout 90° with respect to each other. In addition, the combination ofrotational joints 808, 814, 820, 828 permit movement in four separateplanes, it being possible for at least one pair of said planes (e.g., asdefined by joints 808, 820 or as defined by joints 814, 828) to beparallel to one another and it also being possible for there to be twopairs of parallel planes provided by the joints (e.g., as defined byjoints 808, 820 and as defined by joints 814, 828). The combination ofrotational joints 808, 814, 820, 828 also preferably permits movement infour separate planes which may be nonparallel to one another.

In the exemplary embodiment, linear length adjustment portion 824 formsa sliding mechanism in which a first sliding member 830 is coupled to asecond sliding member 832 and slidably associated with one another.Preferably, constant friction sliding is provided by members 830, 832.Also in the exemplary embodiment, members 830, 832 are restricted tomove with respect to one another along central sliding axis 834.

Member 830 for example may be coupled to a coupling portion 836 such aswith a plurality of screws 838. Preferably, coupling portion 836 isconfigured and dimensioned to be received and slide in a grooved portionor track 832 a formed in member 832. Members 830, 832 may be coupled toone another with a set screw 839 which extends through and is permittedto translate along the length of slot 840 in member 832. The shaft ofset screw 839 extends into member 834. In some embodiments, set screw839 may be tightened so that the head thereof bears against member 832to adjust the friction between the members 830, 832 with respect to eachother.

In alternate embodiments, the shaft of set screw 839 and the width ofslot 840 may be sized so that if no coupling portion 836 is provided,movement of members 830, 832 is guided along axis 834.

Another rotational joint 842 is disposed proximate the free end ofportion 824 opposite the free end at which rotational joint 828 isdisposed. Joint 842 is disposed along an axis 844. In particular, anextension 830 a of member 830 is coupled along axis 844 at rotationaljoint 842 to a joint member 846. Rotational joint 842 may permit a 360°range of rotation about axis 844. Preferably, axes 834, 844 are paralleland disposed in different planes.

Joint member 846 is coupled along an axis 848 at yet another rotationaljoint 850 to a laparoscopic device retaining portion 852. Rotationaljoint 850 may permit a 360° range of rotation about axis 848.Laparoscopic device retaining portion 852 for example may be a clampformed by a pair of jaw members 852 a, 852 b that are spring biasedtoward one another with a spring 852 c at a laparoscopic device graspingregion 852 d. Preferably, laparoscopic device grasping region 852 d issized to receive a laparoscopic device such as an endoscopic camera,shown schematically as device 854. Thus, grasping region 852 d may besized, for example, to grasp a 5 mm and/or 10 mm laparoscope. In theexemplary embodiment, axes 844, 848 are disposed at about 90° withrespect to each other.

Retaining portion 852 preferably may be used to secure the shaft portionof a laparoscopic device such as an endoscopic camera. A sterile sleevedrape may be used to cover the entire apparatus and to be imbricatedinto grasping region 852 d. Preferably, while spring-biased jaw membersare configured to hold the laparoscopic device securely, they alsopermit the device to be manually rotated about its linear axis withenough frictional resistance to prevent undesired rotational movement.

The rotational joints of holder 800 such as rotational joints 814, 816for example may be formed as follows. A threaded screw 856 is disposedwith the head thereof abutting a first washer 858 a which optionallyrests on a second washer 858 b. Washers 858 a, 858 b rest on a ledgesuch as ledge 860 in member 816. The shaft of screw 856 extends throughcoaxial holes 862, 864 in adjacent components such as members 810, 816,and is threadably received in a nut 866 that rests against a washer 868abutting ledge 870 in member 810. Members 810, 816 may be separated fromone another with a washer 872. A sleeve 874 optionally may be providedwith a hole therein through which the shaft of screw 856 extends and isguided. Sleeve 874 may be disposed proximate the head of screw 856 orremote from the head.

Thus, laparoscopic device 854 may be positioned as desired using thecombined freedom of movement provided by rotational joints 808, 814,820, 828, 842, 850, linear length adjustment portion 824, as well as therotation provided by coupling portion 802 when received in portion 82 offree handle 62 of articulating arm assembly 14.

In one preferred exemplary embodiment, holder 800 moves with fivedegrees of freedom, with the sixth degree being accommodated by rotationof laparoscopic device 854 within laparoscopic device retaining portion852. Preferably, frictional movement is provided by rotational joints808, 814, 820, 828, 842, 850, linear length adjustment portion 824, aswell as coupling portion 802 when received in portion 82 of free handle62 of articulating arm assembly 14. Preferably, the friction issufficient to hold the laparoscopic device regardless of orientation butselected so that the device is easily movable for reorientation throughmanual manipulation by a user. Higher frictional resistance to allow formovement of the working envelope may be provided by curvilineararticulating arm assembly 12, as described herein. It should be noted,however, that the ease of movement between relatively moving componentsmay be selected as desired as a function of the friction between saidcomponents. Thus, different embodiments of holder 800 may be providedwith different amounts of friction for rotational joints 808, 814, 820,828, 842, 850, linear length adjustment portion 824, as well as couplingportion 802.

Turning next to FIGS. 4F-4U, yet another exemplary embodiment of alaparoscopic instrument holder 900 according to the present invention isshown. Holder 900 includes a coupling portion 902 in the form of a postthat optionally may include a circumferential groove therein (notshown). Coupling portion 902 preferably is configured to be received inportion 82 of free handle 62 of articulating arm assembly 14, as will bedescribed later. Holder 900 includes a body portion 904 coupled alongaxis 906 at a first rotational joint 908 to a first joint member 910. Inthe exemplary embodiment, first rotational joint 908 may permit a 360°range of rotation about axis 906.

In some embodiments, a series of rotational joints may be provided. Inthe exemplary embodiment, first member 910 is coupled along an axis 912at a second rotational joint 914 to a second joint member 916. Secondrotational joint 914 may permit a 360° range of rotation about axis 912.Second joint member 916 is coupled along an axis 918 at a thirdrotational joint 920 to a linear length adjustment portion 924, whichwill be described shortly. Third rotational joint 920 may permit a 360°range of rotation about axis 918. Preferably, third rotational joint 914is disposed proximate a free end of portion 924.

In one preferred exemplary embodiment, axes 906, 912 are disposed atabout 90° with respect to each other, and axes 912, 918 are disposed atabout 90° with respect to each other. In addition, the combination ofrotational joints 908, 914, 920 permits movement in three separateplanes, it being possible for at least one pair of said planes (e.g., asdefined by joints 908, 920) to be parallel to one another. Thecombination of rotational joints 908, 914, 920 also preferably permitsmovement in three separate planes which may be nonparallel to oneanother.

In the exemplary embodiment, linear length adjustment portion 924 formsa sliding mechanism in which a first sliding member 930 is coupled to asecond sliding member 932 and slidably associated with one another.Preferably, constant friction sliding is provided by members 930, 932.Also in the exemplary embodiment, members 930, 932 are restricted tomove with respect to one another along central sliding axis 934.Advantageously, linear length adjustment portion 924 permits a user toreposition a laparoscopic device 954, for example into and out of anopening in a patient, with gross movement in a linear direction, ascompared to angulation. For example, linear length adjustment portion924 may permit about 6 inches of linear movement of a device 954 held byholder 900.

Member 930 may be provided with a first slot 930 a and member 932 may beprovided with a second slot 932 a, with each of slots 930 a, 932 a beingdisposed centrally along axis 934. First and second slots 930 a, 932 aeach may have a length S₁, S₂, respectively, along axis 934, and lengthsS₁, S₂ may be about the same as one another. In an exemplary preferredembodiment, lengths S₁, S₂ each may be about 5.5 inches. In thepreferred exemplary embodiment, members 930, 932 are coupled to eachother by coupling assemblies 936 extending from fixed positions withrespect to and proximate free ends 930 b, 932 b thereof.

Each coupling assembly 936 includes a female threaded round standoff 936a that threadably receives truss head Phillips machine screws 936 b, 936c at opposing ends thereof. Standoff 936 a extends through a plainbearing 936 d which is sized to slide and be guided in a respective slot930 a, 930 b generally constrained for movement along axis 934. Bearing936 d extends through a plastic thrust bearing 936 e positioned betweenmembers 930, 932. A member 930, 932 is captivated between plastic thrustbearing 936 e and a second plastic thrust bearing 936 f. A stainlesssteel round flat washer 936 g and a curved disc spring 936 h areprovided between bearing 936 f and the head of screw 936 c as shown,with bearing 936 d abutting washer 936 f. Spring 936 h maintains tensionbetween thrust bearings 936 e, 936 g. Finally, another curved discspring 936 i is provided and seats in a recess 930 c or 932 c of amember 930, 932, respectively. Curved disc spring 936 i allows forgreater machining tolerances for recesses 930 c, 932 c and preferablykeeps bearing 936 d in contact with washer 936 f. Coupling assemblies936 thus allow some adjustment of tensioning so that a desired level offorce permits movement of members 930, 932 with respect to one another.By loosening or tightening each of assemblies 936, frictional resistanceto sliding or telescoping of members 930, 932 with respect to each othermay be selected.

Another rotational joint 942 is disposed proximate the free end ofportion 924 opposite the free end at which rotational joint 920 isdisposed. Joint 942 is disposed along an axis 944. In particular, anextension 930 a of member 930 is coupled along axis 944 at rotationaljoint 942 to a joint member 946. Rotational joint 942 may permit a 360°range of rotation about axis 944. Preferably, axes 934, 944 are paralleland disposed in different planes.

Joint member 946 is coupled along an axis 948 at yet another rotationaljoint 950 to a laparoscopic device retaining portion 952. Rotationaljoint 950 may permit a 360° range of rotation about axis 948.Laparoscopic device retaining portion 952, for example, may be a clampformed by a pair of jaw members 952 a, 952 b with a laparoscopic devicegrasping region 952 d formed by jaw portions that are spring biasedtoward one another and handle regions that are spring biased away fromone another, the biasing accomplished using a spring 952 c. Preferably,laparoscopic device grasping region 952 d is sized to receive alaparoscopic device such as an endoscopic camera, shown schematically asdevice 954. Thus, grasping region 952 d may be sized, for example, tograsp a 5 mm and/or 10 mm laparoscope (as shown in FIG. 4O, twocylindrical regions are sized for this purpose). In the exemplaryembodiment, axes 944, 948 are disposed at about 90° with respect to eachother.

In order to provide sufficient clamping strength so that a laparoscopicdevice 954 may be securely and releasably retained within graspingregion 952 d of retaining portion 952, without undesired slippage orrotation, a strong spring mechanism is provided. In particular, as shownin FIGS. 4P-4U, spring 952 c in part elastically biases jaw members 952a, 952 b toward one another so that grasping region 952 d is in a closedposition. In the preferred exemplary embodiment, spring 952 c is a Type302 stainless steel torsion spring providing a torque of about 21in.-lbs. (McMaster-Carr part number 9287K103 with the followingcharacteristics: 90° deflection angle clockwise wound, spring outerdiameter about 0.9 inch, wire diameter about 0.1 inch, length about 3.5inches, maximum rod outer diameter about 0.5 inch, body length/springlength at torque about 0.6 inch, and about 3.25 active coils). However,in alternate embodiments, other elastic members instead of a torsionspring may be used and other spring characteristics may be specified aslong as proper retention is provided in region 952 d. Thus, even forcesdue to power cords, etc., that may be associated with a laparoscopicdevice 954 may be sufficiently countered while device 954 is disposed ingrasping region 952 d.

Because of the substantial torque provided by spring 952 c to securelyretain a laparoscopic device 954 in grasping region 952 d, a user mayneed very significant hand strength to be able to compress the handleportions of jaw members 952 a, 952 b toward one another. To enhanceusability in view of the torque of spring 952 c, jaw member 952 a has aforked, bifurcated design with a first portion 952 a ₁ having a U-shapedregion that receives a second portion 952 a ₂. A first pin 953 apivotally associates portions 952 a ₁ and 952 a ₂ to one another, whilea second pin 953 b pivotally associates second portion 952 a ₂ to leverlink 955. Lever link 955 is further pivotally associated with jaw member952 b with a third pin 953 c. A boss 959 a of first portion 952 a ₁ witha through hole therein is received in the through hole of a boss 959 bof jaw member 952 b and these jaw members 952 a, 952 b are coupled toone another with a screw 957 a that extends in the through hole of boss959 a and tightly abuts a coaxial set screw 957 b. Spring 952 c isdisposed about boss 959 b with one leg resting against ledge 961 a andthe other leg resting against ledge 961 b of jaw members 952 a, 952 b,respectively. During operation, in order to open grasping region 952 d,a user may grasp in one hand and squeeze (1) portion 952 a ₁ of jaw 952a which forms a first handle region and (2) jaw member 952 b which formsa second handle region. The use of a jaw member 952 a having portions952 a ₁ and 952 a ₂ as well as lever link 955 provides a mechanicaladvantage to the user when changing the size of the openings in graspingregion 952 d, e.g. to allow insertion or release of a laparoscopicdevice 954 therein. Preferably, the mechanical advantage is such thatthe turning force applied by a user to move jaw members 952 a, 952 bwith respect to one another is less than half the turning forceotherwise required for the spring 952 c.

In an exemplary preferred embodiment, when jaw members 952 a, 952 b areclosed as shown in FIGS. 4P and 4Q, portion 952 a ₂ is separated fromportion 952 b by an angle J of about 35°.

Retaining portion 952 preferably may be used to secure the shaft portionof a laparoscopic device such as an endoscopic camera. A sterile sleevedrape may be used to cover the entire apparatus and to be imbricatedinto grasping region 952 d. Preferably, while spring-biased jaw membersare configured to hold the laparoscopic device securely, they alsopermit the device to be manually rotated about its linear axis withenough frictional resistance to prevent undesired rotational movement.

The rotational joints of holder 900 such as rotational joints 914, 920for example may be formed as follows. An internally threaded bolt 956 isdisposed with the head thereof abutting a first washer 958 a. The washer958 a abuts a first side of a joint member such as member 916 while asecond washer 958 b abuts an opposite side of member 916 with bolt 956extending therethrough. The shaft of bolt 956 extends through hole 962and a coaxial hole in an adjacent component such as member 932. Anexternally threaded bolt 964 is threadably received in internallythreaded bolt 956.

In another exemplary embodiment, the rotational joints of holder 900such as rotational joints 908, 914, 920, 942, 950 for example may beformed with thrust bearings as follows. Although in FIGS. 4V and 4W anexemplary rotational joint 920 is shown, the construction of this jointalso may reflect the construction of exemplary rotational joints 908,914, 942, 950 according to this embodiment. Rotational joint 920 couplesjoint member 916 and sliding member 932 (shown in phantom). Joint 920includes a central screw 970 which is threadably received in a threadedhole 916 a in joint member 916. A Belleville or conical washer 972 abutshead 970 a of screw 970 as well as a steel ball thrust bearing 974(which for example may be carbon steel or stainless steel). Washer 972creates a spring tension to broaden the window of adjustability ofholder 900 during assembly and accommodates slight wear that may occurin operation of holder 900. In turn, thrust bearing 974 is mounted on asleeve 976 which extends from within a central opening in thrust bearing974 to within a recessed region in joint member 916. Rotational joint920 further includes a pair of washers 978, 980, preferably formed ofstainless steel, and a spacer 982 disposed therebetween, togethermounted on sleeve 976. Washer 978 abuts and preferably is bonded tojoint member 916 while washer 980 abuts and preferably is bonded tosliding member 932. Washers 978, 980 may rotate freely with respect tospacer 982. Spacer 982 for example may be formed of Delrin® AF Blend(Acetal homopolymer, PTFE-filled). As is known in the art, a highperformance miniature steel ball thrust bearing 974 for example may beformed of a pair of precision chrome-steel washers 974 a, 974 b and aball cage 974 c that is bronze or stainless steel with steel balls 974 ddisposed therein (e.g., McMaster-Carr part number 7806K63). In use,rotational joint 920 advantageously accommodates thrust loads—it canaccommodate axial thrust along the axis of the “shaft” it supports—whilealso providing desired rotational movement between joint member 916 andsliding member 932. Although a steel ball thrust bearing 972 is shown,other types of thrust bearing constructions instead may be used, andalso other types of bearings instead may be used. Moreover, althoughrotational joint 920 with thrust bearing 972 has been shown in theexemplary context of joint member 916 and sliding member 932, in thepresent embodiment such joint constructions with thrust bearings may beused in one or more, and preferably each of rotational joints 908, 914,920, 942, 950.

While holder 900 for example is shown in FIGS. 4F and 4G with a couplingportion 902 in the form of a post that couples to body portion 904,another exemplary embodiment of a coupling portion 990 coupled to bodyportion 904 is shown in FIGS. 4X-4Z. Coupling portion 990 is configured,for example, as an adaptor for coupling holder 900 to other types ofarrangements as known in the art. Thus, holder 900 may be attached to avariety of positioning arms not limited for example to the curvilineararticulating arm assembly 12 in FIG. 1. Portion 990 includes a centralhole 992 that receives a projection 904 a extending from an end of bodyportion 904. Body portion 904 and coupling portion 990 are furtheraligned with a pin 994 extending in holes in portions 904, 990 that arecoaxial when in alignment with one another. An interface lock 996extends into member 990 a of coupling portion 990 and is rotatablyassociated with projection 904 a of body portion 904. Interface lock 996for example may include a knurled knob portion 996 a, a cylindrical post996 b, a sleeve 996 c, and a set screw 996 d. Exemplary operation ofsuch an interface lock 996 is described elsewhere herein with respect toan interface lock 683 shown in FIG. 6U.

Thus, laparoscopic device 954 may be positioned as desired using thecombined freedom of movement provided by rotational joints 908, 914,920, 942, 950, linear length adjustment portion 924, as well as therotation provided by coupling portion 902 when received in portion 82 offree handle 62 of articulating arm assembly 14.

Preferably, frictional movement is provided by rotational joints 908,914, 920, 942, 950, linear length adjustment portion 924, as well ascoupling portion 902 when received in portion 82 of free handle 62 ofarticulating arm assembly 14, as described with respect to holder 800above. Preferably the friction is sufficient to hold the laparoscopicdevice regardless of orientation but selected so that the device iseasily movable for reorientation through manual manipulation by a user.Preferably, when a user positions a laparoscopic device 954 using holder900, the rotational and linear movements provided by the components ofholder 900 provide a generally uniform feel to the user. In other words,during manual manipulation of a device 954 coupled to holder 900, itfeels to the user as though the user encounters the same degree ofresistance to movement of the laparoscopic device 954 regardless of thedirection in which device 954 is moved/oriented. In one exemplarypreferred embodiment, rotational joints 908, 914, 920 proximate couplingportion 902 for interfacing with articulating arm assembly 14 may haveabout two times the frictional resistance to movement as rotationaljoints 942, 950 proximate laparoscopic device retaining portion 952.

Next, with reference to FIGS. 5A-5H, yet another exemplary embodiment ofa laparoscopic instrument holder 1000 according to the present inventionis shown. As with previous embodiments, in an exemplary embodimentholder 1000 includes three rotational axes at a proximal end and tworotational axes at a distal end. Holder 1000 includes a coupling portion1002 in the form of a post. Coupling portion 1002 preferably isconfigured to be received in portion 82 of free handle 62 ofarticulating arm assembly 14, as will be described later. Holder 1000includes a body portion 1004 coupled along axis 1006 at a firstrotational joint 1008 to a first joint member 1010. In the exemplaryembodiment, first rotational joint 1008 may permit a 360° range ofrotation about axis 1006.

In some embodiments, a series of rotational joints may be provided. Inthe exemplary embodiment, first member 1010 is coupled along an axis1012 at a second rotational joint 1014 to a second joint member 1016.Second rotational joint 1014 may permit a 360° range of rotation aboutaxis 1012. Second joint member 1016 is coupled along an axis 1018 at athird rotational joint 1020 to a linear length adjustment portion 1024,which will be described shortly. Third rotational joint 1020 may permita 360° range of rotation about axis 1018. Preferably, third rotationaljoint 1014 is disposed proximate a free end of portion 1024.

In one preferred exemplary embodiment, axes 1006, 1012 are disposed atabout 90° with respect to each other, and axes 1012, 1018 are disposedat about 90° with respect to each other. In addition, the combination ofrotational joints 1008, 1014, 1020 permits movement in three separateplanes, it being possible for at least one pair of said planes (e.g., asdefined by joints 1008, 1020) to be parallel to one another. Thecombination of rotational joints 1008, 1014, 1020 may permit movement inthree separate planes which may be nonparallel to one another.

In the exemplary embodiment, linear length adjustment portion 1024 formsa sliding mechanism in which a generally tubular first sliding member1030 is coupled to a generally tubular second sliding member 1032 andare slidably associated with one another. Portion 1024 forms anextendable section of holder 1000 that for example providesadjustability to the length of holder 1000. In the exemplary embodiment,members 1030, 1032 are restricted to move with respect to one anotheralong central sliding axis 1034. Advantageously, linear lengthadjustment portion 1024 permits a user to reposition a laparoscopicdevice 1054, for example into and out of an opening in a patient, withgross movement in a linear direction, as compared to angulation. Forexample, linear length adjustment portion 1024 may permit about 5 orabout 6 inches of linear movement of a device 1054 held by holder 1000.

Member 1030 preferably is received within, and telescopes with respectto member 1032. As shown in FIG. 5C, member 1032 is hollow and isprovided with a slot 1032 a. A roller key 1034 a is secured to member1030 with a rivet 1034 b; a piston member 1036 is coupled to a free endof member 1030 (see FIG. 5E) and rivet 1034 b extends in a coaxiallydisposed holes 1036 a, 1030 a in members 1036, 1030 respectively. Rollerkey 1034 a coupled to member 1030 is movable within slot 1032 a ofmember 1032 and preferably is a miniature high precision stainless steelball bearing. A cover 1037 may be secured to member 1032 over slot 1032a, for example, for safety and aesthetic reasons. Member 1032 also maybe provided with a bushing 1038 to provide support for member 1030 andto assist in preventing a sterile sleeve drape covering holder 1000 frombeing caught during movement of member 1030 with respect to member 1032.Bushing 1038 includes a plurality of fingers 1038 a disposed radiallywith respect to axis 1034. Advantageously, the use of fingers 1038 aallows an adequate interference fit to be provided with minimal dragbetween fingers 1038 a and the outer surface of member 1030 to preventthe sterile sleeve drape covering holder 1000 from being inadvertentlycaught during movement. Bushing 1038 may be formed, for example, ofDelrin® AF Blend (Acetal homopolymer, PTFE-filled).

As shown in FIG. 5E, piston member 1036 is spring-loaded. In particular,a spring 1036 b and a plunger 1036 c are disposed within a hollowcylindrical region 1036 d in piston member 1036 for movement along axis1036 e. Preferably axis 1036 e is disposed perpendicular to axis 1034.By providing the spring/plunger arrangement, a consistent drag force bymay be provided for movement of members 1030, 1032 with respect to eachother as plunger 1036 c bears against the inner wall of member 1032. Inan exemplary embodiment, the following components and materials may beused: spring 1036 b may be stainless, ½″ long×0.36″ OD×0.032″ wire; theplunger may be 0.43″ long with an OD of 0.375 and may be made of Delrin®AF Blend; the depth of the hole in the piston may be ¾″ and the diameterof the piston may be 0.86″, sized for clearance to the ID of member1032.

Turning back to FIG. 5A, another rotational joint 1042 is disposedproximate the free end of member 1030 opposite the free end of member1032 at which rotational joint 1020 is disposed. Joint 1042 is disposedalong axis 1034. Rotational joint 1042 may permit a 360° range ofrotation about axis 1034. Joint member 1046 is coupled along an axis1048 at yet another rotational joint 1050 to a laparoscopic deviceretaining portion 1052. Rotational joint 1050 may permit a 360° range ofrotation about axis 1048. Laparoscopic device retaining portion 1052,for example as shown in FIG. 5H, may be a clamp formed by a pair of jawmembers 1052 a, 1052 b with a laparoscopic device grasping region 1052 dformed by jaw portions that are spring biased toward one another andhandle regions that are spring biased away from one another, the biasingaccomplished using a spring 1052 c. Preferably, laparoscopic devicegrasping region 1052 d is sized to receive a laparoscopic device such asan endoscopic camera, shown schematically as device 1054. Preferably,grasping region 1052 d is formed by material softer than aluminum toprevent marring or denting of surfaces of delicate laparoscopic device1054 which typically is thin-walled. In the exemplary preferredembodiment, polyurethane covers 1052 e are provided. Covers 1052 e forexample may be formed of 85 or 95 durometer polyurethane, permittingdevices 1054 to even be twisted out of grasping region 1052 d withoutdamage occurring. In the exemplary embodiment, axes 1034, 1048 aredisposed at about 90° with respect to each other.

Further details concerning retaining portion 1052 were previouslyprovided in the context of retaining portion 952 of a previousembodiment.

Thus, retaining portion 1052 preferably may be used to secure the shaftportion of a laparoscopic device such as an endoscopic camera. A sterilesleeve drape may be used to cover the entire apparatus and to beimbricated into grasping region 1052 d. Preferably, while spring-biasedjaw members are configured to hold the laparoscopic device securely,they also permit the device to be manually rotated about its linear axiswith enough frictional resistance to prevent undesired rotationalmovement.

An exemplary rotational joint 1014 is shown in FIG. 5G. Each of joints1008, 1014, 1020 for example may have the same construction, and joint1014 is described in particular. Although similar to these joints, thejoints 1042, 1050 proximate retaining portion 1052 have similarconstructions to joint 920 shown in FIGS. 4V-4W a previously described(e.g., with two stainless steel washers and a Delrin® AF Blend spacertherebetween that is not bonded to its surroundings). However, as willbe described, components in these various joints may be formed ofdifferent materials depending on whether the joint is located near theproximal or distal end of holder 1000.

In a preferred exemplary embodiment, joint 1014 may include a thrustbearing. Rotational joint 1014 couples joint member 1010 to joint member1016 (shown in phantom). Joint 1014 includes a central screw 1070 whichis threadably received in a threaded hole 1010 a in joint member 1010. Apair of Belleville or conical washers 1072 are disposed proximate head1070 a of screw 1070 as well as a high performance miniature steel ballthrust bearing 1074 that for example may be formed of a pair ofprecision chrome-steel washers 974 a, 974 b and a ball cage 974 c thatis bronze or stainless steel with steel balls 974 d disposed therein(e.g., McMaster-Carr part number 7806K63). In turn, thrust bearing 1074is mounted on a sleeve 1076 which extends from within a central openingin thrust bearing 1074 to within a recessed region in joint member 1016.Rotational joint 1014 further includes a washer 1078 preferably formedof stainless steel and a spacer 1082 adjacent sleeve 1076. Washer 1078abuts joint member 1010. Washer 1078 preferably is bonded to jointmember 1010 while spacer 1082 preferably is bonded to joint member 1016,it being possible for washer 1078 and spacer 1082 to rotate with respectto each other. The use of such a joint with a thrust bearing wasdescribed previously with respect to joint 920 of another embodiment,and the previous description also applies to this embodiment.

In a preferred exemplary embodiment, members 1030, 1032 are formed of6061-T6 aluminum due to the strength to weight ratio of this material.However, other materials could be used for example thin wall steel.Washers such as washers 1072 may be formed of stainless steel.

The spacers such as spacer 1082 in rotational joints 1008, 1014, 1020 atthe proximal end may be formed of Multifil™ sliding bearing materialwhich is polytetrafluoroethylene (PTFE)-based and available from GGBNorth America LLC. Advantageously, the Mutifil material has low stictionfor the present application—it shows almost no signs of “sticking” inthe operating conditions of holder 1000. On the other hand, the spacersin the rotational joints at the distal end such as joints 1042, 1050 maybe formed of Delrin® AF Blend (Acetal homopolymer, PTFE-filled).Different materials were used for the spacers at the proximal and distalends for several reasons. First, Multifil was only available in alimited range of thicknesses. Because the spacers at the proximal endwere of relatively large diameters (1⅛ inch), forces against the spacerscould be spread over this relatively large area thus allowing a“smaller” thickness of spacer to be used without risking plasticdeformation. The spacers at the distal end proximate retaining portion1052 have comparatively small diameters (¾ inch), and thus “larger”spacer thickness was needed to accommodate forces on these spacerswithout risking plastic deformation. Multifil was not available in thethickness needed for the spacers at the distal end and thus anothermaterial (Delrin® AF Blend) was chosen. Second, stiction appeared to bemore of an issue in joints at the proximal end near body portion 1004(than in joints proximate retaining portion 1052); Multifil thus was thepreferred material for addressing stiction concerns.

In an exemplary embodiment, holder 1000 may have a fully telescopedlength of about 19.5 inches as measured from the first rotational joint1008 at the proximal end proximate body portion 1004 to the center ofthe clamp jaw cover 1052 e; the unextended length of holder 1000 may beabout 14.25 inches. Thus, telescoping action may provide about 5 toabout 5.5 inches of adjustment in length of holder 1000.

Joints 1008, 1014, and 1020 each are set to about 2 ft-lbs of torque,while joint 1042 is set to about 0.8 ft-lbs of torque and joint 1050 isset to about 1.2 ft-lbs of torque. The telescoping action of members1030, 1032 may be set to have about an axial force of about 1 lb.

In use, the port in a patient into which a device 1054 is introduced mayserve as a fulcrum. The clamp of holder 1000 preferably is capable ofholding about ¼ lb. of weight from device 1054 when holder 1000 is fullyextended. Although a typical endoscopic scope may weigh about ¼ lb.,various cables associated with the scope increase the weight that mustbe supported. However, support is further provided by the port formed inthe body into which the scope is inserted, helping to assist inaccommodating the additional weight.

The rotational joints described herein, for example, may permit limitedrotation such as rotation through an angle of about 180° or an angle ofabout 270°, or may permit about 360° of rotation about an axis of therotational joint.

Next, an exemplary method of using holder 900 is described although thismethod applies to other holders described herein such as holder 1000. Inuse, the position of holder 900 should be checked for suitable workingrange near the planned camera port site. The optimum attachment pointfor the articulating arm assembly 14 for example on a surgical bedrailing should be determined after the patient is positioned and asleepand before the prep. Initially, linear length adjustment portion 924need not be telescoped, although portion 924 should be fully extendedfor draping. Assembly 14 should be oriented to near vertical forprepping and draping the patient and the arm. The drape for assembly 14preferably should be placed after the skin prep but before the finallarge procedure drape is placed. A separate skirt/half-sheet drape maybe clipped around the base of the system after the large patient drapeis placed. Assembly 14 then should be contoured closely to the patientto minimize its footprint and brought adjacent to the camera port. Inuse, the assembly 14 should be closely contoured to the patient andholder 900 disposed approximately parallel to the skin (perpendicular tothe port) to minimize interference and clutter. Also, although it ispossible that in one combination joints 910, 914, 920 may be alignedgenerally in the same plane, it is desirable to have at least one ofthese joint out of plane relative to the others to start. If thelaparoscopic device 954 is an endoscopic camera, preferably the shaft ofthe device is grasped in clamp 952 as close as possible to the camerabody. A laparoscopic device 954 coupled to holder 900 may be moved, forexample, in six degrees of freedom with the combination of rotationaljoints 942, 950 and grasping region 952 d of clamp 952 which permitsrotation of device 954 therein.

Referring now to FIGS. 5I-5N, a further exemplary embodiment of alaparoscopic instrument holder 1100 according to the present inventionis shown. Holder 1100 is similar to holder 1000 but instead includesball and socket joints proximate the laparoscopic device retainingportion, as will be described. Otherwise, the description of holder 1000above applies to holder 1100.

Exemplary holder 1100 includes three rotational axes at a proximal end,two rotational axes at a distal end, and separately two ball joints forrotational motion at the distal end permitting articulation with respectto an axis defined by a shaft as will be described.

Holder 1100 includes a coupling portion 1102 in the form of a post.Coupling portion 1102 preferably is configured to be received in portion82 of free handle 62 of articulating arm assembly 14, as describedseparately herein. Holder 1100 includes a body portion 1104 coupledalong axis 1106 at a first rotational joint 1108 to a first joint member1110. In the exemplary embodiment, first rotational joint 1108 maypermit a 360° range of rotation about axis 1106.

In the exemplary embodiment, first member 1110 is coupled along an axis1112 at a second rotational joint 1114 to a second joint member 1116.Second rotational joint 1114 may permit a 360° range of rotation aboutaxis 1112. Second joint member 1116 is coupled along an axis 1118 at athird rotational joint 1120 to a linear length adjustment portion 1124,as described previously with respect to linear length adjustment portion1024 of holder 1000. Third rotational joint 1120 may permit a 360° rangeof rotation about axis 1118. Preferably, third rotational joint 1114 isdisposed proximate a free end of portion 1124.

In one preferred exemplary embodiment, axes 1106, 1112 are disposed atabout 90° with respect to each other, and axes 1112, 1118 are disposedat about 90° with respect to each other. In addition, the combination ofrotational joints 1108, 1114, 1120 permits movement in three separateplanes, it being possible for at least one pair of said planes (e.g., asdefined by joints 1108, 1120) to be parallel to one another. Thecombination of rotational joints 1108, 1114, 1120 may permit movement inthree separate planes which may be nonparallel to one another.

In the exemplary embodiment, linear length adjustment portion 1124 formsa sliding mechanism for telescoping action of portions 1130, 1132 withrespect to each other, as described previously with respect to holder1000.

Another rotational joint 1142 is disposed proximate the free end ofmember 1130 opposite the free end of member 1132 at which rotationaljoint 1120 is disposed. Joint 1142 is disposed along axis 1134.Rotational joint 1142 may permit a 360° range of rotation about axis1134. Joint member 1146 is coupled along an axis 1148 at yet anotherrotational joint 1150 to a ball and socket joint portion 1152, which inturn is coupled to a laparoscopic device retaining portion 1154.Rotational joint 1150 may permit a 360° range of rotation about axis1148. Laparoscopic device retaining portion 1154 for example may besimilar to portion 1052 described previously with respect to holder1000, and is shown in FIG. 5I with a laparoscopic device 1154 a retainedtherein.

Turning particularly to FIGS. 5J-5N, ball and socket joint portion 1152next will be described. In the exemplary embodiment, ball and socketjoint portion 1152 includes a pair of ball and socket joints, althoughin other embodiments a single ball and socket joint or more than twoball and socket joints may be provided. Exemplary portion 1152 thusincludes a first socket 1155 for receiving a first ball 1156 as well asa second socket 1158 for receiving a second ball 1160. Balls 1156, 1160are rigidly coupled to one another by a shaft 1162 received in opposingbores 1164, 1166, respectively. Shaft 1162 is secured to balls 1156,1160 by pins 1168, 1170 that extend respectively in through holes 1156a, 1160 a. As shown in FIG. 5M, pins 1168, 1170 also extend throughshaft 1162. Pins 1168, 1170 may be secured to balls 1156, 1160 and/orshaft 1162 such as with a press fit.

Each of sockets 1155, 1158 have an opening 1155 a, 1158 a through whichballs 1156, 1160 respectively protrude. In use, for example, themovement of socket 1155 with respect to ball 1156 is limited by the sizeof the opening 1155 a because the internal rim defining opening 1155 alimits the movement of shaft 1162. In one preferred exemplaryembodiment, each of sockets 1155, 1158 can be angulated by as much asabout 45° transverse to shaft 1162, while sockets 1155, 1158 also mayhave a 360° range of rotation about shaft 1162.

Socket 1155 is secured to a member 1172, while similarly socket 1158 issecured to a member 1174, for example by the components being threadablycoupled to each other. First portion 1172 a preferably has outerthreading and is associated with internal threading on socket 1155.Thus, the threadable association of first portion 1172 a of member 1172and socket 1155 permits socket 1155, particularly the internal rimdefining opening 1155 a thereof, to bear against ball 1156 with a userselected degree of tightness. A similar adjustment system may be usedwith respect to socket 1158 and member 1174.

Set screws 1176 also serve to prevent rotation and for example locksocket 1155 to member 1172, as well as lock socket 1158 to member 1174.In the exemplary embodiment, three sets screws 1176 are disposed about120° apart from one another for each socket. For example, set screws1176 are threadably associated with threaded holes in socket 1155 (asshown for example in FIG. 5K) and bear against portion 1172 c of member1172. A similar locking system may be used with respect to socket 1158and member 1174.

A series of washers also may be provided for each ball and socket pair.For example, balls 1156, 1160 each may be disposed on a washer 1178 a,1178 b. Washers 1178 a, 1178 b may have a concave, recessed portion 1179a, 1179 b of generally spherical contour for receiving a ball 1156, 1160and against which the ball may rotate. Washers 1178 a, 1178 b furthermay include a central protrusion 1180 a, 1180 b, respectively, forreceiving another washer 1182 a, 1182 b. In turn, washers 1182 a, 1182 bmay abut washers 1184 a, 1184 b. In the preferred exemplary embodiment,washers 1178 a, 1178 b are formed of aluminum and are provided to spreadload respectively on balls 1156, 1160 to avoid point loading. Washers1182 a, 1182 b may be formed for example of urethane and act as springsto maintain pressure. Finally, washers 1184 a, 1184 b may be formed forexample of stainless steel and serve to spread load on washers 1182 a,1182 b, respectively. Sockets 1155, 1158 are configured and dimensionedto retain the series of washers therein.

As can be seen in FIG. 5M, member 1174 may include a central hole 1186for receiving a bolt 1186 a and a recessed portion 1188 in which a nut1188 a may be threadably associated with bolt 1186 a. Clamp 1154 may besecured to member 1174 with the combination of bolt 1186 a and nut 1188a.

Although not shown in detail, member 1172 may be formed of a firstportion 1172 a coupled to a second portion 1172 b for example with acentrally disposed bolt housed therein, although alternatively theseportions may be integrally formed.

The ease of motion of sockets 1155, 1158 with respect to their balls1156, 1160, respectively, may be adjusted, for example, based on theamount of threaded engagement of a socket with respect to its associatedmember 1172, 1174.

Holders 100, 300, 400, 500, 800, 900, 1000, 1100 and clamping system 550preferably may be provided with a full cover sleeve drape. Devices 100,300, 400, 500, 550, 800, 900, 1000, 1100 may be formed as a single use,pre-sterilized device, or as a sterilizable, re-usable device, or as anon-sterile re-usable device that is covered by a sterile drape/coverwhen required. Portions of devices 100, 300, 400, 500, 550, 800, 900,1000, 1100 may be disposable.

In one exemplary, preferred embodiment, the holders of the presentinvention may be designed to create a minimum footprint or minimuminterference within the surgical field and be easily sterilized orprotected by a sterile cover. The holders preferably are long enough toreach from an attachment point on or proximate the location of a bedsiderailing to well past the skin entry port of a patient to allow for afull range of movement of the laparoscope, and to have enough pathwayvariability to clear other objects in the surgical field.

Some embodiments of holders may have several modes of operation. Onemode may be free movement with little resistance at the free end. Asecond mode may be moderate resistance at the free end. This may be mostuseful when holding an endoscopic camera. In this instance, theresistance in this second mode preferably should be sufficient tomaintain camera position in the absence of additional external forcewhile at the same time being weak enough to allow a complete range ofthree-dimensional manipulation by the surgeon or assistant using onlyone hand without the need to adjust any locking or unlocking mechanism.A third mode may be fully locked with high resistance to movement at thefree end. This mode may be particularly useful in the case where greaterforce may be required, such as retraction of an internal structure ororgan. In this circumstance, an instrument connection other than, or inaddition to the rotational joints disclosed herein, may be used.

As described above, coupling portion 302 of holder 300 and couplingportion 402 of holder 400 preferably are configured to be received inportion 82 of free handle 62 of articulating arm assembly 14. Thisarticulating arm assembly now will be described.

Turning to FIGS. 6A-6C, an exemplary preferred curvilinear articulatingarm assembly 12 is shown for use with a laparoscopic instrument holder14. Arm assembly includes a central arm 652 with a ball-sleevearrangement that forms joints. In particular, central arm 652 includes aplurality of sleeves 654 with spherical balls 656 disposed therebetweenthus forming ball and socket connections. In the exemplary embodimentshown in the figures, three balls 656 a of a first size are disposedadjacent one another proximate one end of arm 652, while the remainingballs 656 b are of a second size smaller than the first size. Sleeves654 a of a first size and sleeves 654 c of a second size smaller thanthe first size are provided for accommodating balls 656 a, 656 b,respectively, while a transition sleeve 654 b is provided intermediatesleeves 654 a, 654 c as shown for accommodating a ball 656 a on one sideand a ball 656 b on the other side thereof. Sleeves 654 are configuredand dimensioned to receive balls 656 a, 656 b at ends thereof and thuspermit articulating of sleeves with respect to each other. A tensioningwire 658 runs generally centrally through sleeves 654 and balls 656, aswill be further described shortly. Preferably, wire 658 is formed ofmetal. In an exemplary preferred embodiment, wire 658 is Type 302stainless steel wire rope, 1×19 strand, 5/32 inch diameter, with abreaking strength of 3300 lb. (McMaster-Carr part number 3458T27). Oneexemplary operation of a wire tensioning mechanism is shown anddescribed in U.S. Pat. No. 3,858,578 to Milo, which is expresslyincorporated herein by reference thereto. Preferably, curvilineararticulating arm assembly 12 may move with six degrees of freedom.

In the exemplary preferred embodiment, three additional balls 656 a andthree additional sleeves 654 a are provided to the arm assembly 12 shownin FIGS. 6A-6C, with arm assembly 12 having a fully extended(straightened) length of about 40 inches. End effector 14, for example,may add about 4 inches to the length of the arm assembly 12. In otherembodiments, other desired lengths of arm assembly 12 may beaccomplished by changing the number of balls and sleeves. For example,without the three additional balls 656 a and three additional sleeves654 a, arm assembly 12 may have a length of about 32 inches.

A base handle 660 is coupled to central arm 652 on a first end thereof,preferably adjacent a ball 656 a. In addition, a free handle 662 iscoupled to central arm 652 on a second end thereof, preferably adjacenta ball 656 b.

In one preferred exemplary embodiment, a series of larger balls 656 a isprovided proximate base handle 660 to provide stability to curvilineararticulating arm assembly 12. If for example a user such as a surgeonorients assembly 12 by grasping it proximate free handle 662,substantial bending forces may be exerted on central arm 652 proximatebase handle 660. Thus, the use of larger balls 656 a proximate basehandle 660 as compared to smaller balls 656 b proximate free handle 662provides a system with larger surface area balls near base handle 660for additional resistance to rotational movement in that portion ofcentral arm 652 and thus more stability. In alternate embodiments, morethan two different sizes of balls 656 or more than two sets of sizes ofballs 656 may be used, preferably increasing in size toward base handle660. In one alternate embodiment, each of the balls 656 in central arm652 is of increasingly larger size from free handle 662 to base handle660. The use of only two sizes of balls 656 advantageously facilitatesmanufacture and construction of arm assembly 12 because of the need toonly stock two sizes as compared to a larger number of sizes andconcomitantly greater ease of construction because only two sizes needbe assembled to form central arm 652. In yet another alternateembodiment, central arm 652 may be formed of balls 656 that all are thesame size.

Turning to FIG. 6D-6L, base handle 660 will be described. Base handle660 includes a body portion 660 a with levers 666, 668 pivotablyassociated therewith, as well as an extension 660 b that turns screwcoupling 663 and rotates in relation to and independent of body portion660 a. Base handle 660 further includes cam mechanisms 670, 672 as willbe described. Portion 663 b of coupling 663 preferably is noncircularand mechanically engages and is fixed to a like-shaped and sizednon-circular opening in portion 660 c of extension 660 b so thatrotation of extensions 660 b as by gripping and turning by a userimparts like-rotation of coupling 663 for example for demountablecoupling to clamp 16 and further coupling to a surgical table rail 18,as shown for example in FIG. 1. In the preferred exemplary embodiment,coupling 663 comprises a threaded portion 663 d which may be threadablyreceived in a threaded hole 16 a disposed in clamp 16.

Coupling 663 is disposed proximate a first free end 664 a of a stainlesssteel shaft 664 which extends therethrough and is provided with a headthat abuts a shoulder disposed in end 663 c of coupling 663. Preferably,rotation of coupling 663 is independent of rotation of shaft 664. Shaft664 preferably extends through a hole in extension 660 b.

Lever 666 is pivotably coupled to rocker arm 672 with a pin 666 a thatis disposed such that rotation of lever 666 results in eccentricmovement of rocker arm 672. As shown for example in FIGS. 6D-6E,cylindrical projections 666 b of lever 666 are received and rotate inarcuate cradle portions 660 a ₁ of body portion 660 a, while cylindricalprojections 672 b of rocker arm 672 are received and rotate in arcuatecradle portions 660 a ₂ of body portion 660 a. Rotation of lever 666toward screw coupling 663 in direction K lifts pin 666 a, and becauserocker arm 672 rests on pin 666 a, rocker arm 672 is rotated indirection L in an eccentric fashion.

As seen particularly in FIG. 6F, shaft 664 includes a threaded portion664 b the free end of which is threadably associated with a nut 665 a.Shaft 664 extends through a hole in rocker arm 672 and an unthreadedinsert 665 b with a hole therein which assists in guiding travel of rod664 along the longitudinal axis thereof. Pivoting of lever 666 indirection K causes rotation of rocker arm 672, and with shaft 664coupled to nut 665 a and nut 665 a abutting insert 665 b, rod 664 istranslated in direction M.

When coupling 663 is threaded into a like threaded hole by rotation ofextension 660 b, arm assembly 12 is relatively loosely coupled by theconnection of coupling 663 to the hole. To firmly couple arm assembly12, lever 666 may be pivoted in direction K so that threaded portion 663d of coupling 663 also moves in direction M and bears against thethreads of the hole in which it is received. The leverage created byeven slight movement of the threads against the threaded holes, on theorder of tens of thousandths of an inch, creates a wedging effect thatstrongly locks arm assembly 12 to the hole.

Lever 668 of base handle 660 also is pivotably coupled to a rocker arm670 with a pin 668 a that is disposed such that rotation of lever 668results in eccentric movement of rocker arm 670. As shown for example inFIGS. 6D-6H, cylindrical projections 668 b of lever 668 are received androtate in arcuate cradle portions 660 a ₃ of body portion 660 a, whilecylindrical projections 670 b of rocker arm 670 are received and rotatein arcuate cradle portions 660 a ₄ of body portion 660 a. Rotation oflever 668 toward screw coupling 663 in direction N lifts pin 668 a, andbecause rocker arm 670 rests on pin 668 a, rocker arm 670 is rotated indirection P in an eccentric fashion.

A forked member 676, which for example may be formed of stainless steel,is coupled to rocker 670 and includes substantially parallel prongs 676a, 676 b which mate with side walls of rocker 670 as shown. Rocker 670is pivotably associated with forked member 676, with a shaft 677extending through aligned holes in prongs 676 a, 676 b and rocker 670.Shaft 677 may be provided with a head 677 a and an external retainingring 677 b secured in a shaft groove proximate an end opposite head 677a to retain forked member 676 in association therewith and thus withrocker 670. An axial through hole 676 c is provided in tubular portion676 d of forked member 676. Tensioning wire 658 is coupled to forkedmember 676 by inserting an end portion of wire 658 in hole 676 c andswaging tubular portion 676 d so that wire 658, which extends out ofopen end 660 a ₅ of body portion 660 a, is retained by compressionwithin tubular portion 676 d.

When lever 668 is rotated in direction N, shaft 676 translates along thelongitudinal axis M₁ toward coupling 663 creating substantial tension intensioning wire 658 such that movement of curvilinear articulating armassembly 12 may be substantially resisted. In particular, actuation ofsecond lever 668 may increase or decrease the tension in wire 658 asdesired by acting on rocker arm 670. By increasing tension in wire 658,central arm 652 preferably becomes increasingly resistant to movementalthough central arm 652 preferably still may be moved through its fullrange of motion. Thus, a user may orient curvilinear articulating armassembly 12 as desired, and then increase the tension of wire 658 sothat the orientation of arm 652 is releasably fixed. Lever 668preferably has an angular range of movement about pin 668 a of up toabout 180° to permit substantial tension to be generated in tensioningwire 658.

Rockers 670, 672 preferably are associated with each other as with aspring plunger 679 extending from within one rocker 670 into a hole inthe other rocker 672. Spring plunger for example may be a stainlesssteel spring plunger with a round Delrin nose, without a lock element,with ¼″-20 threading, and 3-13 lb. end force (McMaster-Carr part number84765A33). Spring plunger 679 is used as shown because under the forceof gravity, first lever 666 may otherwise tend to move toward a closedposition with in the direction of arrow K. Instead, spring plunger 679applies pressure to rocker arm 672 to set lever 666 to tend to a defaultopen position in which shaft 664 has not otherwise been raised towardopen end 660 a ₅ of body portion 660 a.

In a preferred exemplary embodiment, rocker 670 moves with substantiallygreater eccentricity than rocker 672.

Clamp 16 for use with base handle 660 may be demountably attached tosurgical table rail 18. As previously discussed, actuation of firstlever 666 permits a user to apply a force on coupling 663 so thatmovement is resisted (e.g., in response to an 8 or 10 pound forceapplied to arm 652). In an alternate embodiment which will be furtherdescribed later, screw coupling 664 as shown in FIG. 6A proximate basehandle 660 of arm assembly 12 may be threadably associated with athreaded hole in another support surface.

A preferred exemplary embodiment of clamp 16 is shown in FIG. 6M. Clamp16 includes a threaded hole 16 a for threadably receiving threadedportion 664 of base handle 660. In addition, clamp 16 includes fixed jawportion 16 b and movable jaw portion 16 c which is pivotable about axle16 d and lockable in place using screw mechanism 16 e to firmly coupleclamp 16 to a rail 18 secured between jaw portions 16 b, 16 c.

Next turning to FIGS. 6N-6U, free handle 662 will be described. Freehandle 662 includes a wire receiving portion 680 and an end effectorreceiving portion 681. In particular, wire receiving portion 680preferably is configured to receive a ball 656 b therein, along with anend portion of wire 658. As described previously with respect to basehandle 660, a pivotable lever 682 is associated with free handle 662 andpreferably is coupled to tensioning wire 658 so that actuation of lever682 may increase or decrease the tension in wire 658 as desired byacting on rocker arm 684. By increasing tension in wire 658, central arm652 preferably becomes less flexible. Thus, a user may orientcurvilinear articulating arm assembly 12 as desired, and then increasethe tension of wire 658 so that the orientation of arm 652 is releasablyfixed. Free handle 662 has a body portion 662 a, and lever 682 isrotatable with respect thereto. An interface lock 683 also is rotatablyassociated with body portion 662 a proximate end effector receivingportion 681, as will be described shortly.

Lever 682 is pivotably coupled to rocker arm 684 with a pin 686 a thatis disposed such that rotation of lever 682 results in eccentricmovement of rocker arm 684. Cylindrical projections 682 a of lever 682are received and rotate in arcuate cradle portions 662 a ₁ of bodyportion 662 a, while cylindrical projections 684 a of rocker arm 684 arereceived and rotate in arcuate cradle portions 662 a ₂ of body portion662 a. Rotation of lever 682 toward wire receiving portion 680 indirection T lifts pin 686 a, and because rocker arm 684 rests on pin 686a, rocker arm 684 is rotated in direction U in an eccentric fashion.

Rocker arm 684 includes a hole in which a self-aligning setup washer 690(a two-piece washer with one portion that rocks in another portion) isdisposed. Setup washer 690 for example may be an 18-8 stainless steelself-aligning setup washer, ¼ inch in size, 17/64 inch inner diameter, ½inch outer diameter, and 0.250 inch to 0.281 inch thick (McMaster-Carrpart number 91944A028). A nut 692 also may abut setup washer 690 on theflat upper surface thereof and rock thereon. A threaded stud (not shown)may be swaged to the end of tensioning wire 658 opposite the endattached to forked member 676, thus coupling wire 658 to the threadedstud by compression. The threaded stud may in turn be threadablyassociated with nut 692. Wire 658 is provided with suitable length tospan from forked member 676 to nut 692.

Pivoting of lever 682 in direction T causes rotation of rocker arm 684,and with tensioning wire 658 coupled to nut 692 and nut 692 abuttinginsert 690, tension in wire 658 may be increased. In particular,actuation of lever 682 may increase or decrease the tension in wire 658as desired. By increasing tension in wire 658, central arm 652preferably becomes increasingly resistant to movement although centralarm 652 preferably still may be moved through its full range of motion.Thus, a user may orient curvilinear articulating arm assembly 12 asdesired, and then increase the tension of wire 658 so that theorientation of arm 652 is releasably fixed. Lever 668 preferably has anangular range of movement about pin 686 a of up to about 90° to permittension to be generated in tensioning wire 658.

In the preferred exemplary embodiment, actuation of lever 682 freehandle 662 permits initial tensioning of central arm 652 while stillpermitting restricted movement. And, actuation of lever 668 of basehandle 660 permits substantially greater tensioning of central arm 652while also still permitting restricted movement thereof. Advantageously,with tension created in wire 658 of central arm 652 to restrict movementthereof, the orientation of lever 668 such as with respect to a patientstill may readily be reset or adjusted before lever 666 in base handle660 is actuated to create sufficient force to prevent rotation ofthreaded portion 663 d of coupling 663 in the hole in which it isreceived.

As shown in FIG. 6U, interface lock 683 includes a knurled knob portion683 a and a cylindrical post 683 b that is provided with an arcuatecutout 683 c. Interface lock 683 is coupled to body portion 662 a withset screw 683 d which is threadably received in a threaded hole 662 b inbody portion 662 a. Set screw 683 d is further received in a slot 683 ein post 683 b to lock post 683 b in a position with arcuate cutout 683 coriented to be movable along the longitudinal axis of cylindrical post683 b. Cylindrical post 683 b may be disposed in a disengaged positionin which the axial position of post 683 b is such that arcuate cutout683 c generally follows the inner cylindrical contour of end effectorreceiving portion 681. Also, cylindrical post 683 b may be disposed inan engaged position in which the axial position of post 683 b is suchthat a portion of cylindrical post 683 b other than arcuate cutout 683 cextends past the inner cylindrical contour of end effector receivingportion 681 toward the central longitudinal axis of end effectorreceiving portion 681.

In use, in order for example to couple articulating arm assembly 12 toan end effector such as a holder 100, by capturing post 102 of holder100 in end effector receiving portion 681 of free handle 662, post 102is inserted therein while interface lock 683 is disposed in theaforementioned disengaged position. While lock 683 is in the disengagedposition, post 102 may freely rotate about the central axis of receivingportion 681. Once a desired orientation is set, lock 683 may betranslated along the major axis defined by slot 683 a so that a portionof cylindrical post 683 b of lock 683 is disposed in an engaged positionand bears against post 102. Such interference between post 102 of holder100 and post 683 b of lock 683 provides sufficient pressure so that post102 will remain fixed in rotational position and translation along thelongitudinal axis thereof against the inner cylindrical contour of endeffector receiving portion 681.

In one method of conducting a laparoscopic procedure according to thepresent invention, a curvilinear articulating arm assembly 12 with baseattachment 16 is releasably secured to a surgical table rail 18. Holdersystem 100 is demountably coupled to the free end of arm assembly 12 atfree handle 662, and a laparoscope is releasably retained in holdersystem 100 by locking it in the slot defined between face 122 f andclamping portion 114, with the laparoscope being frictionally held inthe slot in the desired rotational orientation. By articulating thelever 682 at the free end to a locked position, arm assembly 12 willhold position when left alone but can be easily repositioned with onehand without having to loosen or unclamp any other mechanisms. In thismode, arm assembly 12 should have sufficient resistance to hold thelaparoscope in position absent other external forces, much like agooseneck lamp. If locking lever 668 near the base of arm assembly 12 isalso locked then arm assembly 12 will hold position against a muchgreater force, but this lever 668 will then have to be released whenready movement of the arm/scope combination is required.

Preferably, the two rotating joints of holder 100 have complete freedomof motion and cannot be locked, and the scope is engaged by the slotdefined between face 122 f and clamping portion 114 that opens via asyringe-like spring mechanism as previously described. Free movement ofthe scope is allowed by the freely rotating joints of holder 100 thatrespond to user-selected positioning of articulating arm assembly 12while the scope is in the skin port of the patient.

In normal use, knob 124 preferably is backed off so that the springloading of movable clamping jaws 122 operates freely and the scope maybe engaged and disengaged quickly at will.

Once curvilinear articulating arm assembly 12 is fixed in position, thegeometry of the swivel joints of holder 100 in combination with thecurvilinear articulating arm assembly 12 and the laparoscope passingthrough a skin port is designed to result in reliable position holdingfor the scope, yet allow complete freedom of movement by manualrepositioning. There is no need to adjust any locking or tensioningmechanisms because of the geometry of the setup and the resistanceprovided by the arm in its “gooseneck lamp” mode.

In some methods, gross movements of the scope may be accomplished bygrabbing the articulating arm assembly 12 proximate the swivel jointsand reorient the device from that gripping point. For smaller movements,it is possible to simply grab and torque the scope itself.

In one method of use, curvilinear articulating arm assembly 12 isclosely contoured to the patient (approximately parallel to the skin) tominimize interference and clutter, and with the holder such as holder800 extended nearby the endoscopic camera port. The position of armassembly 12 is checked for suitable working range near the planned portsite. The optimum attachment point for the base of the arm assembly 12for example on a surgical bed railing is determined after the patient ispositioned and asleep and before the next preparation phase. Armassembly 12 may be oriented out of the way for prepping and draping. Anarm drape may be placed after the skin prep but before the final largeprocedure drape is placed. A separate skirt/sheet drape may be clippedaround the base after the large drape is placed. Arm assembly 12 may becontoured to the patient and brought adjacent to the camera port. Thescope may be engaged working through the drape for example by pinchingopen the spring loaded clamp of holder 800 and simply invaginating thecover with the scope into the slot. The cover preferably is tough andstretchy and withstands repeated engage/disengage cycles and scoperotation.

Each of the holder systems described herein may be used in accordancewith the aforementioned methods, regardless of spring-loading of theclamping arrangements.

Also, although an exemplary curvilinear articulating arm assembly isdescribed herein, it should be understood that other preferably,curvilinear articulating arm assemblies instead may be used whichpreferably provide six degrees of freedom of movement and permitrelatively rigid positioning such as described herein.

In some embodiments of the present invention, an instrument holdersystem such as system 10 may be coupled to a patient support other thana rail of a table. For example, referring next to FIG. 7, an exemplarysupport system 710 according to the present invention is shown with avariety of components coupled thereto. Support system 710 includes atray 712, curvilinear articulating arm assemblies 12, 716 havingrespective end effectors 100, 720, an IV pole 722, an arm board 724, andrail assemblies 726, 728. A variety of end effectors may be demountablyattached for example to articulating arm assembly 716 to assist atechnician or practitioner with a medical/imaging procedure or provideother features useful with respect to a patient. End effector 720, forexample, is configured as a self-centering abdominal probe bracket.

In one preferred exemplary embodiment, tray 712 may include two pairs ofhold regions 730, each pair being disposed proximate a free cranial end732 or free caudal end 734 of tray 712. In alternate embodiments, othernumbers of hold regions 730 may be provided such as two or more, andhold regions 730 may be provided in other regions of tray 712 such asintermediate ends 732, 734 proximate sides 736, 738. Hold regions 730may be configured as hand holds, or alternatively may be configured toreceive strapping so that tray 712 may be releasably coupled to anotherobject such as an ambulance stretcher, hospital bed, operating roomtable, or imaging scanner table. In some embodiments, handles may becoupled to tray 712. As also shown in FIG. 7, attachment regions 740 areprovided proximate sides 736, 738 for demountably coupling components aspreviously described to tray 712, as will be further described below. Inthe exemplary preferred embodiment, tray 712 is provided with thirteenattachment regions 740, although in alternate embodiments another numberof regions 740 may be provided such as at least one or tray 712 may beprovided with a surgical rail or track permitting substantial freedom ofcoupling of components along the length thereof.

Turning to FIGS. 8A-8C, additional features of tray 712 are shown.Although hand hold regions 730 are not included in the figure, suchregions may be provided as shown in FIG. 7. Attachment regions 740 areprovided in spaced arrangement along the perimeter of tray 712.Preferably, tray 712 includes a central arcuate portion 742 disposedbetween outer ledge portions 744. Preferably, regions 740 are providedon outer ledge portions 744. Central arcuate portion 742 preferably hasan upper concave surface 742 a for receiving a patient and optionally acushion (not shown) for the patient to rest against, and optionallyincludes a lower convex surface 742 b. Preferably, outer ledge portions744 include upper and lower surfaces 744 a, 744 b connected by asidewall 744 c at an angle α with respect to surface 744 b. In apreferred exemplary embodiment, sidewall 744 c is disposed at an angle αbetween about 60° and about 100°, more preferably between about 70° andabout 90°, and most preferably at about 80°.

In a preferred exemplary embodiment, tray 712 is formed of naturalfinish carbon fiber, R-51 foam core, and phenolic. Attenuationpreferably is less than 1 mm Al equivalency. Thus, tray 712 isradiolucent and suitable for use with computed axial tomography (CT)scanners. In other embodiments, tray 712 is formed of a materialsuitable for use with magnetic resonance imaging (MR) scanners. Inaddition, tray 712 preferably supports a load of 900 lbs. evenlydistributed along centerline 746, about which tray 712 may besubstantially symmetric as shown. Indicia 748 optionally may beprovided, as shown for example proximate ends 732, 734. The indicia mayfor example indicate preferred orientation of tray 712 with respect to apatient lying thereon.

In the preferred exemplary embodiment, attachment regions 740 on eachside of tray 712 are evenly spaced from each other by about 6 inchesbetween centers thereof. To accommodate patients and equipment attachedto tray 12, in one preferred embodiment tray 712 has a length of about78 inches, a width of about 21 inches, a generally uniform thickness ofabout 0.9 inch, and a height h of about 2.5 inches. Corners may beprovided with a radius R₁ of about 2 inches. In the preferred exemplaryembodiment, attachment regions 740 preferably accommodate threadedinserts, which may be formed of aluminum.

In some embodiments, tray 712 is sized to hold an adult patient, and maybe between about 180 cm and about 200 cm long. However, it will beappreciated that longer and shorter trays may be provided. In order toaccommodate an adult patient, tray 712 may support an overall weightcapacity of at least about 200 pounds, and preferably at least about 300pounds. However, if a tray 712 is sized for use with a pediatricpatient, tray 712 may only accommodate weights that do not exceed 200pounds, and more preferably do not exceed 100 pounds.

Although the surface of portion 742 of tray 712 is substantially smoothin the preferred exemplary embodiment, in alternate embodiments thesurface may be textured to provide additional resistance to motion ofobjects and/or a patient placed thereon.

Tray 712 thus is suitable for use in multiple environments, and thus may“move” with the patient from one environment (e.g., ambulance) to thenext (e.g., CT scanner) without removing a patient supported thereon.

Turning to FIGS. 9A and 9B, a curvilinear articulating arm assembly suchas assemblies 12, 716 (modified as will be described) may be coupled toa patient support surface 1200 (such as an operating room table) forexample along a rail 1202 using a clamp 1204. Clamp 1204 includes jaws1204 a, 1204 b for securing a curvilinear articulating arm assembly 12,716 to rail 1202. In particular, assemblies 12, 716 are modified toinclude an extension member 1206 which is pivotable with respect to aclamp member 1208 (that includes jaw 1204 a). Jaws 1204 a, 1204 b may betightened against rail 1202 by tightening knob 1210 which in turn drawspivotable jaw 1204 b to engage rail 1202. Extension member 1206 may bepivoted with respect to clamp member 1208 by loosening the couplingtherebetween, using knob 1212. In particular, knob 1212 is coupled to athreaded shaft (not shown) which threably engages clamp member 1208.Such an arrangement may permit angular adjustment of the curvilineararticulating arm assembly 12, 716 through a range of about 180°. Also,such a clamp 1204 advantageously permits a stable mounting of anarticulating arm with quick and easy adjustment of the positioningthereof. Thus, a laparoscopic instrument holder such as holder 1000,1100 may be coupled to a curvilinear articulating arm assembly 12, 716which further may be coupled to a clamp 1204, thus permitting the holder1000, 1100 to be secured to a patient support surface.

While various descriptions of the present invention are described above,it should be understood that the various features can be used singly orin any combination thereof. Therefore, this invention is not to belimited to only the specifically preferred embodiments depicted herein.For example, although the holders described herein are described in thecontext of laparoscopic instrument holder systems that may place acamera through a port in the skin into a working cavity, the holdersalso may be used for example in the context of procedures that examinethe interior of a bodily canal or hollow organ such as the colon,bladder, or stomach. The present invention may be applied in a varietyof fields including but not limited to general surgery, orthopedics,gynecology, urology, and cardiology. In the context of laparoscopy, thesystems of the present invention for example may be used to assist insurgical procedures involving the intestines, stomach, or gallbladderwhich may benefit from the visual inspection made possible by alaparoscope.

Further, it should be understood that variations and modificationswithin the spirit and scope of the invention may occur to those skilledin the art to which the invention pertains. Accordingly, all expedientmodifications readily attainable by one versed in the art from thedisclosure set forth herein that are within the scope and spirit of thepresent invention are to be included as further embodiments of thepresent invention. The scope of the present invention is accordinglydefined as set forth in the appended claims.

1. A laparoscopic instrument holder for positioning a laparoscopicdevice comprising: a central portion comprising a first memberoperatively associated with a second member, the members selectivelymovable with respect to one another along a central axis, the centralportion having a proximal end defined by the first member and a distalend defined by the second member; at least three proximal rotationaljoints coupled to the first member proximate the proximal end; at leasttwo distal rotational joints coupled to the second member proximate thedistal end; a first ball and socket joint coupled to a distal rotationaljoint; a second ball and socket joint coupled to the first ball andsocket joint; a clamp configured and dimensioned for retaining alaparoscopic device, the clamp coupled to the second ball and socketjoint; and a coupling portion proximate a first of the proximalrotational joints.
 2. The laparoscopic instrument holder of claim 1,wherein the members telescope with respect to one another.
 3. Thelaparoscopic instrument holder of claim 1, wherein the second member isslidably received in the first member.
 4. The laparoscopic instrumentholder of claim 1, wherein each of the proximal and distal rotationaljoints comprises a thrust bearing.
 5. The laparoscopic instrument holderof claim 4, wherein the thrust bearing is a steel ball thrust bearing.6. The laparoscopic instrument holder of claim 1, wherein each ball andsocket joint comprises a ball and a washer.
 7. The laparoscopicinstrument holder of claim 1, wherein the first ball and socket jointcomprises a first ball and the second ball and socket joint comprises asecond ball, and wherein the first and second balls are rigidly coupledto each other.
 8. The laparoscopic instrument holder of claim 7, whereinthe first and second balls are rigidly coupled to each other by a shaft.9. The laparoscopic instrument holder of claim 8, wherein each socketcomprises a hole with a rim for limiting angulation of the shaft.
 10. Amethod of positioning a laparoscopic device in a skin port of a mammal,the method comprising: securing the laparoscopic device to a holdercomprising at least three proximal rotational joints, at least twodistal rotational joints, and at least two ball and socket joints;coupling the holder to a curvilinear articulating arm; disposing thelaparoscopic device partially within the skin port; positioning thelaparoscopic device by selectively articulating the curvilineararticulating arm and selectively orienting portions of the holder withrespect to one another.
 11. The method of claim 10, wherein thelaparoscopic device is retained in a clamp, and wherein the positioningcomprises angulating the clamp using the ball and socket joints.
 12. Themethod of claim 10, wherein the holder further comprises first andsecond members coupled to one another, and wherein the positioningcomprises selectively moving the first and second members with respectto each other.
 13. The method of claim 12, wherein the first and secondmembers telescope with respect to each other.
 14. The method of claim10, wherein the holder is manually operated.
 15. The method of claim 10,further comprising: coupling the curvilinear articulating arm to apatient support.